I

103D CONGRESS

2D SESSION H. R. 5252

To amend the Social Security Act and related Acts to make miscellaneous

and technical amendments, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

OCTOBER 7, 1994

Mr. STARK introduced the following bill; which was referred jointly to the

Committees on Ways and Means and Education and Labor

OCTOBER 7, 1994

Committees on Ways and Means and Energy and Commerce discharged,

considered, and passed

A BILL

To amend the Social Security Act and related Acts to make

miscellaneous and technical amendments, and for other

purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Social Security Act

5 Amendments of 1994’’.

6 SEC. 2. REFERENCES IN ACT; TABLE OF CONTENTS.

7 (a) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex8 cept as otherwise specifically provided, whenever in this
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1 Act an amendment is expressed in terms of an amendment

2 to or repeal of a section or other provision, the reference

3 shall be considered to be made to that section or other

4 provision of the Social Security Act.

5 (b) REFERENCES TO OBRA.—In this Act, the terms

6 ‘‘OBRA–1986’’, ‘‘OBRA–1987’’, ‘‘OBRA–1989’’,

7 ‘‘OBRA–1990’’, and ‘‘OBRA–1993’’ refer to the Omnibus

8 Budget Reconciliation Act of 1986 (Public Law 99–509),

9 the Omnibus Budget Reconciliation Act of 1987 (Public

10 Law 100–203), the Omnibus Budget Reconciliation Act

11 of 1989 (Public Law 101–239), the Omnibus Budget Rec12 onciliation Act of 1990 (Public Law 101–508), and the

13 Omnibus Budget Reconciliation Act of 1993 (Public Law

14 103–66), respectively.

15 (c) TABLE OF CONTENTS.—The table of contents is

16 as follows:

Sec. 1. Short title.

Sec. 2. References in Act; table of contents.

TITLE I—MEDICARE PROVISIONS

Subtitle A—Provisions Relating to Part A

Sec. 101. Provisions relating to adjustments to standardized amounts for wages

and wage-related costs.

Sec. 102. Essential access community hospital (EACH) amendments.

Sec. 103. Provisions relating to rural health transition grant program.

Sec. 104. Psychology services in hospitals.

Sec. 105. Medicare-dependent, small rural hospitals and sole community hospitals.

Sec. 106. Skilled nursing facilities.

Sec. 107. Notification of availability of hospice benefit.

Sec. 108. Clarifying expertise of individuals to serve on the Prospective Payment Assessment Commission.

Sec. 109. Authority for budget neutral adjustments for changes in payment

amounts for transfer cases.
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Sec. 110. Clarification of DRG payment window expansion; miscellaneous and

technical corrections.

Subtitle B—Provisions Relating to Part B

PART I—PHYSICIANS’ SERVICES

Sec. 121. Development and implementation of resource-based methodology for

practice expenses.

Sec. 122. Geographic cost of practice index refinements.

Sec. 123. Extra-billing limits.

Sec. 124. Relative values for pediatric services.

Sec. 125. Administration of claims relating to physicians’ services.

Sec. 126. Miscellaneous and technical corrections.

PART II—DURABLE MEDICAL EQUIPMENT

Sec. 131. Certification of suppliers.

Sec. 132. Restrictions on certain marketing and sales activities.

Sec. 133. Beneficiary liability for noncovered services.

Sec. 134. Adjustments for inherent reasonableness.

Sec. 135. Miscellaneous and technical corrections.

PART III—OTHER ITEMS AND SERVICES

Sec. 141. Ambulatory surgical center services.

Sec. 142. Study of medicare coverage of patient care costs associated with clinical trials of new cancer therapies.

Sec. 143. Study of annual cap on amount of medicare payment for outpatient

physical therapy and occupational therapy services.

Sec. 144. Payment of part B premium late enrollment penalties by States.

Sec. 145. Application of mammography certification requirements.

Sec. 146. Coverage of services of speech-language pathologists and audiologists.

Sec. 147. Miscellaneous and technical corrections.

Subtitle C—Provisions Relating to Parts A and B

Sec. 151. Medicare secondary payer reforms.

Sec. 152. Physician ownership and referral.

Sec. 153. Definition of FMGEMS examination for payment of direct graduate

medical education.

Sec. 154. Qualified medicare beneficiary outreach.

Sec. 155. Hospital agreements with organ procurement organizations.

Sec. 156. Peer review organizations.

Sec. 157. Health maintenance organizations.

Sec. 158. Home health agencies.

Sec. 159. Permanent extension of authority to contract with fiscal

intermediaries and carriers on other than a cost basis.

Sec. 160. Miscellaneous and technical corrections.

Subtitle D—Provisions Relating to Medicare Supplemental Insurance Policies

Sec. 171. Standards for medicare supplemental insurance policies.

Sec. 172. 6-month extension of period for issuance of medicare select policies.

TITLE II—MATERNAL AND CHILD HEALTH SERVICES BLOCK

GRANT PROGRAM
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Subtitle A—Child Welfare, Foster Care, Adoption

Sec. 201. Increase in authorization of appropriations for the Maternal and

Child Health Services Block Grant Program.

Sec. 202. Required protections for foster children.

Sec. 203. Conformity reviews.

Sec. 204. States required to report on measures taken to comply with the Indian Child Welfare Act.

Sec. 205. Child welfare traineeships.

Sec. 206. Dispositional hearing.

Sec. 207. Elimination of foster care ceilings and of authority to transfer unused

foster care funds to child welfare services programs.

Sec. 208. Demonstration projects.

Sec. 209. Placement accountability.

Sec. 210. Payments of State claims for foster care and adoption assistance.

Sec. 211. Effect of failure to carry out State plan.

Subtitle B—Child Support Enforcement

Sec. 212. Reports to credit bureaus on persons delinquent in child support payments.

Sec. 213. Technical amendments to provision on State paternity establishment

programs.

Sec. 214. Agreement to assist in locating missing children under the parent locator service.

Subtitle C—Supplemental Security Income

Sec. 221. Definition of disability for children under age 18 applied to all individuals under age 18.

Subtitle D—Aid to Families With Dependent Children

Sec. 231. Simplification of income and eligibility verification system.

Sec. 232. Measurement and reporting of welfare receipt.

Sec. 233. New Hope demonstration project.

Sec. 234. Delay in requirement that outlying areas operate an AFDC–up program.

Sec. 235. State option to use retrospective budgeting without monthly reporting.

Subtitle E—JOBS Program

Sec. 241. Expansion of coverage for Indian tribes.

Sec. 242. Report to the Congress with respect to performance standards in the

JOBS program.

Subtitle F—Other Provisions

Sec. 261. Extension of demonstration to expand job opportunities.

Sec. 262. Early childhood development projects.

Sec. 263. Reallocation of funds under title XX for empowerment and enterprise

grants.

Sec. 264. Corrections related to the income security and human resources provisions of OBRA–1990.

Sec. 265. Technical corrections related to the human resource and income security provisions of OBRA–1989.
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Sec. 266. Technical correction related to the human resource and income security provisions of OBRA–1993.

Sec. 267. Elimination of obsolete provisions relating to treatment of the earned

income tax credit.

Sec. 268. Redesignation of certain provisions.

1 TITLE I—MEDICARE PROVISIONS

2 Subtitle A—Provisions Relating to

3 Part A

4 SEC. 101. PROVISIONS RELATING TO ADJUSTMENTS TO

5 STANDARDIZED AMOUNTS FOR WAGES AND

6 WAGE-RELATED COSTS.

7 (a) USE OF OCCUPATIONAL MIX IN GUIDELINES FOR

8 DETERMINATION OF AREA WAGE INDEX.—

9 (1) IN GENERAL.—Section 1886(d)(10)(D)(i)(I)

10 (42 U.S.C. 1395ww(d)(10)(D)(i)(I)) is amended by

11 inserting ‘‘(to the extent the Secretary determines

12 appropriate)’’ after ‘‘taking into account’’.

13 (2) EFFECTIVE DATE.—The amendment made

14 by paragraph (1) shall take effect as if included in

15 the enactment of OBRA–1989.

16 (b) CONFORMING AMENDMENTS RELATING TO GEO17 GRAPHIC AREA USED TO DETERMINE WAGE INDEX AP18 PLICABLE TO HOSPITAL.—(1) Section 1886(d)(8)(C) (42

19 U.S.C. 1395ww(d)(8)(C)), as amended by section

20 13501(b)(1) of OBRA–1993, is amended—

21 (A) in clause (iv), by striking ‘‘paragraph (1)’’

22 and inserting ‘‘paragraph (10)’’; and
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1 (B) by adding at the end the following new

2 clause:

3 ‘‘(v) This subparagraph shall apply with respect to

4 discharges occurring in a fiscal year only if the Secretary

5 uses a method for making adjustments to the DRG pro6 spective payment rate for area differences in hospital wage

7 levels under paragraph (3)(E) for the fiscal year that is

8 based on the use of Metropolitan Statistical Area classi9 fications.’’.

10 (2) Section 1886(d)(10) (42 U.S.C. 1395ww(d)(10))

11 is amended—

12 (A) in subparagraph (C)(i)(II), by striking ‘‘the

13 area wage index applicable’’ and inserting ‘‘the fac14 tor used to adjust the DRG prospective payment

15 rate for area differences in hospital wage levels that

16 applies’’; and

17 (B) in subparagraph (D)—

18 (i) by redesignating clause (ii) as clause

19 (iii), and

20 (ii) by inserting after clause (i) the follow21 ing new clause:

22 ‘‘(ii) Notwithstanding clause (i), if the Secretary uses

23 a method for making adjustments to the DRG prospective

24 payment rate for area differences in hospital wage levels

25 under paragraph (3)(E) that is not based on the use of
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1 Metropolitan Statistical Area classifications, the Secretary

2 may revise the guidelines published under clause (i) to the

3 extent such guidelines are used to determine the appro4 priateness of the geographic area in which the hospital is

5 determined to be located for purposes of making such ad6 justments.’’.

7 (c) ADJUSTMENT OF LABOR AND NON-LABOR POR8 TIONS OF STANDARDIZED AMOUNTS.—Section

9 1886(d)(3)(A)(iii) (42 U.S.C. 1395ww(d)(3)(A)(iii)) is

10 amended by adding at the end the following: ‘‘For dis11 charges occurring on or after October 1, 1994, the Sec12 retary shall adjust the ratio of the labor portion to non13 labor portion of each average standardized amount to

14 equal such ratio for the national average of all standard15 ized amounts.’’.

16 SEC. 102. ESSENTIAL ACCESS COMMUNITY HOSPITAL

17 (EACH) AMENDMENTS.

18 (a) TREATMENT OF INPATIENT HOSPITAL SERVICES

19 PROVIDED IN RURAL PRIMARY CARE HOSPITALS.—

20 (1) IN GENERAL.—Section 1820(f)(1)(F) (42

21 U.S.C. 1395i–4(f)(1)(F)) is amended to read as fol22 lows:

23 ‘‘(F) subject to paragraph (4), provides not

24 more than 6 inpatient beds (meeting such con25 ditions as the Secretary may establish) for pro-
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1 viding inpatient care to patients requiring sta2 bilization before discharge or transfer to a hos3 pital, except that the facility may not provide

4 any inpatient hospital services—

5 ‘‘(i) to any patient whose attending

6 physician does not certify that the patient

7 may reasonably be expected to be dis8 charged or transferred to a hospital within

9 72 hours of admission to the facility; or

10 ‘‘(ii) consisting of surgery or any

11 other service requiring the use of general

12 anesthesia (other than surgical procedures

13 specified by the Secretary under section

14 1833(i)(1)(A)), unless the attending physi15 cian certifies that the risk associated with

16 transferring the patient to a hospital for

17 such services outweighs the benefits of

18 transferring the patient to a hospital for

19 such services.’’.

20 (2) LIMITATION ON AVERAGE LENGTH OF

21 STAY.—Section 1820(f) (42 U.S.C. 1395i–4(f)) is

22 amended by adding at the end the following new

23 paragraph:

24 ‘‘(4) LIMITATION ON AVERAGE LENGTH OF IN25 PATIENT STAYS.—The Secretary may terminate a
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1 designation of a rural primary care hospital under

2 paragraph (1) if the Secretary finds that the average

3 length of stay for inpatients at the facility during

4 the previous year in which the designation was in ef5 fect exceeded 72 hours. In determining the compli6 ance of a facility with the requirement of the pre7 vious sentence, there shall not be taken into account

8 periods of stay of inpatients in excess of 72 hours

9 to the extent such periods exceed 72 hours because

10 transfer to a hospital is precluded because of inclem11 ent weather or other emergency conditions.’’.

12 (3) CONFORMING AMENDMENT.—Section

13 1814(a)(8) (42 U.S.C. 1395f(a)(8)) is amended by

14 striking ‘‘such services’’ and all that follows and in15 serting ‘‘the individual may reasonably be expected

16 to be discharged or transferred to a hospital within

17 72 hours after admission to the rural primary care

18 hospital.’’.

19 (4) GAO REPORTS.—Not later than 2 years

20 after the date of the enactment of this Act, the

21 Comptroller General shall submit reports to Con22 gress on—

23 (A) the application of the requirements

24 under section 1820(f) of the Social Security Act

25 (as amended by this subsection) that rural pri-
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1 mary care hospitals provide inpatient care only

2 to those individuals whose attending physicians

3 certify may reasonably be expected to be dis4 charged within 72 hours after admission and

5 maintain an average length of inpatient stay

6 during a year that does not exceed 72 hours;

7 and

8 (B) the extent to which such requirements

9 have resulted in such hospitals providing inpa10 tient care beyond their capabilities or have lim11 ited the ability of such hospitals to provide

12 needed services.

13 (b) DESIGNATION OF HOSPITALS.—

14 (1) PERMITTING DESIGNATION OF HOSPITALS

15 LOCATED IN URBAN AREAS.—

16 (A) IN GENERAL.—Section 1820 (42

17 U.S.C. 1395i–4) is amended—

18 (i) by striking paragraph (1) of sub19 section (e) and redesignating paragraphs

20 (2) through (6) as paragraphs (1) through

21 (5);

22 (ii) in subsection (e)(1)(A) (as redes23 ignated by subparagraph (A))—

24 (I) by striking ‘‘is located’’ and

25 inserting ‘‘except in the case of a hos-
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1 pital located in an urban area, is lo2 cated’’,

3 (II) by striking ‘‘, (ii)’’ and in4 serting ‘‘or (ii)’’, and

5 (III) by striking ‘‘or (iii)’’ and all

6 that follows through ‘‘section,’’; and

7 (iii) in subsection (i)(1)(B), by strik8 ing ‘‘paragraph (3)’’ and inserting ‘‘para9 graph (2)’’.

10 (B) NO CHANGE IN MEDICARE PROSPEC11 TIVE PAYMENT.—Section 1886(d)(5)(D) (42

12 U.S.C. 1395ww(d)(5)(D)) is amended—

13 (i) in clause (iii)(III), by inserting ‘‘lo14 cated in a rural area and’’ after ‘‘that is’’,

15 and

16 (ii) in clause (v), by inserting ‘‘located

17 in a rural area and’’ after ‘‘in the case of

18 a hospital’’.

19 (2) PERMITTING HOSPITALS LOCATED IN AD20 JOINING STATES TO PARTICIPATE IN STATE PRO21 GRAM.—

22 (A) IN GENERAL.—Section 1820 (42

23 U.S.C. 1395i–4) is amended—

24 (i) by redesignating subsection (k) as

25 subsection (l); and
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1 (ii) by inserting after subsection (j)

2 the following new subsection:

3 ‘‘(k) ELIGIBILITY OF HOSPITALS NOT LOCATED IN

4 PARTICIPATING STATES.—Notwithstanding any other

5 provision of this section—

6 ‘‘(1) for purposes of including a hospital or fa7 cility as a member institution of a rural health net8 work, a State may designate a hospital or facility

9 that is not located in the State as an essential access

10 community hospital or a rural primary care hospital

11 if the hospital or facility is located in an adjoining

12 State and is otherwise eligible for designation as

13 such a hospital;

14 ‘‘(2) the Secretary may designate a hospital or

15 facility that is not located in a State receiving a

16 grant under subsection (a)(1) as an essential access

17 community hospital or a rural primary care hospital

18 if the hospital or facility is a member institution of

19 a rural health network of a State receiving a grant

20 under such subsection; and

21 ‘‘(3) a hospital or facility designated pursuant

22 to this subsection shall be eligible to receive a grant

23 under subsection (a)(2).’’.

24 (B) CONFORMING AMENDMENTS.—(i) Sec25 tion 1820(c)(1) (42 U.S.C. 1395i–4(c)(1)) is
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1 amended by striking ‘‘paragraph (3)’’ and in2 serting ‘‘paragraph (3) or subsection (k)’’.

3 (ii) Paragraphs (1)(A) and (2)(A) of sec4 tion 1820(i) (42 U.S.C. 1395i–4(i)) are each

5 amended—

6 (I) in clause (i), by striking ‘‘(a)(1)’’

7 and inserting ‘‘(a)(1) (except as provided

8 in subsection (k))’’, and

9 (II) in clause (ii), by striking ‘‘sub10 paragraph (B)’’ and inserting ‘‘subpara11 graph (B) or subsection (k)’’.

12 (c) SKILLED NURSING SERVICES IN RURAL PRIMARY

13 CARE HOSPITALS.—Section 1820(f)(3) (42 U.S.C. 1395i–

14 4(f)(3)) is amended by striking ‘‘because the facility’’ and

15 all that follows and inserting the following: ‘‘because, at

16 the time the facility applies to the State for designation

17 as a rural primary care hospital, there is in effect an

18 agreement between the facility and the Secretary under

19 section 1883 under which the facility’s inpatient hospital

20 facilities are used for the furnishing of extended care serv21 ices, except that the number of beds used for the furnish22 ing of such services may not exceed the total number of

23 licensed inpatient beds at the time the facility applies to

24 the State for such designation (minus the number of inpa25 tient beds used for providing inpatient care pursuant to
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1 paragraph (1)(F)). For purposes of the previous sentence,

2 the number of beds of the facility used for the furnishing

3 of extended care services shall not include any beds of a

4 unit of the facility that is licensed as a distinct-part skilled

5 nursing facility at the time the facility applies to the State

6 for designation as a rural primary care hospital.’’.

7 (d) DEADLINE FOR DEVELOPMENT OF PROSPECTIVE

8 PAYMENT SYSTEM FOR INPATIENT RURAL PRIMARY

9 CARE HOSPITAL SERVICES.—Section 1814(l)(2) (42

10 U.S.C. 1395f(l)(2)) is amended by striking ‘‘January 1,

11 1993’’ and inserting ‘‘January 1, 1996’’.

12 (e) PAYMENT FOR OUTPATIENT RURAL PRIMARY

13 CARE HOSPITAL SERVICES.—

14 (1) IMPLEMENTATION OF PROSPECTIVE PAY15 MENT SYSTEM.—Section 1834(g) (42 U.S.C.

16 1395m(g)) is amended—

17 (A) in paragraph (1), by striking ‘‘during

18 a year before 1993’’ and inserting ‘‘during a

19 year before the prospective payment system de20 scribed in paragraph (2) is in effect’’; and

21 (B) in paragraph (2), by striking ‘‘January

22 1, 1993,’’ and inserting ‘‘January 1, 1996,’’.

23 (2) NO USE OF CUSTOMARY CHARGE IN DETER24 MINING PAYMENT.—Section 1834(g)(1) (42 U.S.C.
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1 1395m(g)(1)) is amended by adding at the end the

2 following new flush sentence:

3 ‘‘The amount of payment shall be determined under

4 either method without regard to the amount of the

5 customary or other charge.’’.

6 (f) CLARIFICATION OF PHYSICIAN STAFFING RE7 QUIREMENT FOR RURAL PRIMARY CARE HOSPITALS.—

8 Section 1820(f)(1)(H) (42 U.S.C. 1395i–4(f)(1)(H)) is

9 amended by striking the period and inserting the follow10 ing: ‘‘, except that in determining whether a facility meets

11 the requirements of this subparagraph, subparagraphs (E)

12 and (F) of that paragraph shall be applied as if any ref13 erence to a ‘physician’ is a reference to a physician as de14 fined in section 1861(r)(1).’’.

15 (g) TECHNICAL AMENDMENTS RELATING TO PART

16 A DEDUCTIBLE, COINSURANCE, AND SPELL OF ILL17 NESS.—(1) Section 1812(a)(1) (42 U.S.C. 1395d(a)(1))

18 is amended—

19 (A) by striking ‘‘inpatient hospital services’’ the

20 first place it appears and inserting ‘‘inpatient hos21 pital services or inpatient rural primary care hos22 pital services’’;

23 (B) by striking ‘‘inpatient hospital services’’ the

24 second place it appears and inserting ‘‘such serv25 ices’’; and
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1 (C) by striking ‘‘and inpatient rural primary

2 care hospital services’’.

3 (2) Sections 1813(a) and 1813(b)(3)(A) (42 U.S.C.

4 1395e(a), 1395e(b)(3)(A)) are each amended by striking

5 ‘‘inpatient hospital services’’ each place it appears and in6 serting ‘‘inpatient hospital services or inpatient rural pri7 mary care hospital services’’.

8 (3) Section 1813(b)(3)(B) (42 U.S.C.

9 1395e(b)(3)(B)) is amended by striking ‘‘inpatient hos10 pital services’’ and inserting ‘‘inpatient hospital services,

11 inpatient rural primary care hospital services’’.

12 (4) Section 1861(a) (42 U.S.C. 1395x(a)) is amend13 ed—

14 (A) in paragraph (1), by striking ‘‘inpatient

15 hospital services’’ and inserting ‘‘inpatient hospital

16 services, inpatient rural primary care hospital serv17 ices’’; and

18 (B) in paragraph (2), by striking ‘‘hospital’’

19 and inserting ‘‘hospital or rural primary care hos20 pital’’.

21 (h) AUTHORIZATION OF APPROPRIATIONS.—Section

22 1820(l) (42 U.S.C. 1395i–4(l)), as redesignated by sub23 section (c)(2)(A), is amended by striking ‘‘1990, 1991,

24 and 1992’’ and inserting ‘‘1990 through 1997’’.
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1 (i) EFFECTIVE DATE.—The amendments made by

2 this section shall take effect on the date of the enactment

3 of this Act.

4 SEC. 103. PROVISIONS RELATING TO RURAL HEALTH TRAN5 SITION GRANT PROGRAM.

6 (a) ELIGIBILITY OF RURAL PRIMARY CARE HOS7 PITALS FOR GRANTS.—

8 (1) IN GENERAL.—Section 4005(e)(2) of

9 OBRA–1987 is amended in the matter preceding

10 subparagraph (A) by inserting ‘‘any rural primary

11 care hospital designated by the Secretary under sec12 tion 1820(i)(2) of the Social Security Act, or’’ after

13 ‘‘means’’.

14 (2) EFFECTIVE DATE.—The amendment made

15 by paragraph (1) shall apply to grants made on or

16 after October 1, 1994.

17 (b) EXTENSION OF AUTHORIZATION OF APPROPRIA18 TIONS.—Section 4005(e)(9) of OBRA–1987 is amended—

19 (1) by striking ‘‘1989 and’’ and inserting

20 ‘‘1989,’’; and

21 (2) by striking ‘‘1992’’ and inserting ‘‘1992

22 and $30,000,000 for each of fiscal years 1993

23 through 1997’’.
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1 (c) FREQUENCY OF REQUIRED REPORTS.—Section

2 4008(e)(8)(B) of OBRA–1987 is amended by striking

3 ‘‘every 6 months’’ and inserting ‘‘every 12 months’’.

4 SEC. 104. PSYCHOLOGY SERVICES IN HOSPITALS.

5 Section 1861(e)(4) (42 U.S.C. 1395x(e)(4)) is

6 amended by striking ‘‘physician;’’ and inserting ‘‘physi7 cian, except that a patient receiving qualified psychologist

8 services (as defined in subsection (ii)) may be under the

9 care of a clinical psychologist with respect to such services

10 to the extent permitted under State law;’’.

11 SEC. 105. MEDICARE-DEPENDENT, SMALL RURAL HOS12 PITALS AND SOLE COMMUNITY HOSPITALS.

13 (a) MEDICARE DEPENDENT, SMALL RURAL HOS14 PITALS.—

15 (1) CLARIFICATION OF ADDITIONAL PAY16 MENT.—Section 1886(d)(5)(G)(ii)(I) (42 U.S.C.

17 1395ww(d)(5)(G)(ii)(I)), as amended by section

18 13501(e)(1) of OBRA–1993, is amended by striking

19 ‘‘the first 3 12-month cost reporting periods that

20 begin’’ and inserting ‘‘the 36-month period begin21 ning with the first day of the cost reporting period

22 that begins’’.

23 (2) CONFORMING TARGET AMOUNTS TO EXTEN24 SION OF ADDITIONAL PAYMENTS.—Section

25 1886(b)(3)(D) (42 U.S.C. 1395ww(b)(3)(D)) is
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1 amended in the matter preceding clause (i) by strik2 ing ‘‘March 31, 1993’’ and inserting ‘‘September 30,

3 1994’’.

4 (b) CLARIFICATION OF UPDATES.—Section

5 1886(b)(3)(B)(iv)(II) (42 U.S.C.

6 1395ww(b)(3)(B)(iv)(II)), as added by section

7 13501(a)(2) of OBRA–1993, is amended by striking

8 ‘‘(taking into account’’ and all that follows through

9 ‘‘1994)’’ and inserting ‘‘(adjusted to exclude any portion

10 of a cost reporting period beginning during fiscal year

11 1993 for which the applicable percentage increase is deter12 mined under subparagraph (I))’’.

13 SEC. 106. SKILLED NURSING FACILITIES.

14 (a) CONSTRUCTION OF WAGE INDEX.—Not later

15 than 1 year after the date of the enactment of this Act,

16 the Secretary of Health and Human Services shall begin

17 to collect data on employee compensation and paid hours

18 of employment in skilled nursing facilities for the purpose

19 of constructing a skilled nursing facility wage index ad20 justment to the routine service cost limits required under

21 section 1888(a)(4) of the Social Security Act.

22 (b) CLARIFICATION OF REPEAL OF UTILIZATION RE23 VIEW REQUIREMENTS.—

24 (1) IN GENERAL.—(A) Section 1814(a)(5) (42

25 U.S.C. 1395f(a)(5)) is amended—
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1 (i) by striking ‘‘and with respect’’ and all

2 that follows through ‘‘regulations’’;

3 (ii) by striking ‘‘or skilled nursing facility,

4 as the case may be’’; and

5 (iii) by striking ‘‘or facility’’.

6 (B) Section 1866(d) (42 U.S.C. 1395cc(d)) is

7 amended—

8 (i) by striking ‘‘or skilled nursing facility’’;

9 (ii) by striking ‘‘or facility’’ each place it

10 appears;

11 (iii) by striking ‘‘or for post-hospital’’ and

12 all that follows through ‘‘the case may be’’; and

13 (iv) by striking ‘‘, or (in the case of’’ and

14 all that follows through ‘‘transfer agreement,’’.

15 (2) EFFECTIVE DATE.—The amendments made

16 by paragraph (1) shall take effect as if included in

17 the enactment of OBRA–1987.

18 (c) CONFORMING AMENDMENTS TO NURSING HOME

19 REFORM.—

20 (1) SUSPENSION OF DECERTIFICATION OF

21 NURSES AIDE TRAINING AND COMPETENCY EVALUA22 TION PROGRAMS BASED ON EXTENDED SURVEYS.—

23 (A) IN GENERAL.—Section

24 1819(f)(2)(B)(iii)(I)(b) (42 U.S.C. 1395i–

25 3(f)(2)(B)(iii)(I)(b)) is amended by striking the
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1 semicolon and inserting the following: ‘‘, unless

2 the survey shows that the facility is in compli3 ance with the requirements of subsections (b),

4 (c), and (d) of this section;’’.

5 (B) EFFECTIVE DATE.—The amendment

6 made by subparagraph (A) shall take effect as

7 if included in the enactment of OBRA–1990.

8 (2) REQUIREMENTS FOR CONSULTANTS CON9 DUCTING REVIEWS ON USE OF DRUGS.—

10 (A) IN GENERAL.—Section 1819(c)(1)(D)

11 (42 U.S.C. 1395i–3(c)(1)(D)) is amended by

12 adding at the end the following sentence: ‘‘In

13 determining whether such a consultant is quali14 fied to conduct reviews under the preceding sen15 tence, the Secretary shall take into account the

16 needs of nursing facilities under this title to

17 have access to the services of such a consultant

18 on a timely basis.’’.

19 (B) EFFECTIVE DATE.—The amendment

20 made by subparagraph (A) shall take effect as

21 if included in the enactment of OBRA–1987.

22 (3) INCREASE IN MINIMUM AMOUNT REQUIRED

23 FOR SEPARATE DEPOSIT OF PERSONAL FUNDS.—

24 (A) IN GENERAL.—Section

25 1819(c)(6)(B)(i) (42 U.S.C. 1395i–
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1 3(c)(6)(B)(i)) is amended by striking ‘‘$50’’

2 and inserting ‘‘$100’’.

3 (B) EFFECTIVE DATE.—The amendment

4 made by subparagraph (A) shall take effect

5 January 1, 1995.

6 (4) DUE PROCESS PROTECTIONS FOR NURSE

7 AIDES.—

8 (A) PROHIBITING STATE FROM INCLUDING

9 UNDOCUMENTED ALLEGATIONS IN NURSES

10 AIDE REGISTRY.—Section 1819(e)(2)(B) (42

11 U.S.C. 1395i–3(e)(2)(B)) is amended by strik12 ing the period at the end of the first sentence

13 and inserting the following: ‘‘, but shall not in14 clude any allegations of resident abuse or ne15 glect or misappropriation of resident property

16 that are not specifically documented by the

17 State under such subsection.’’.

18 (B) DUE PROCESS REQUIREMENTS FOR

19 REBUTTING ALLEGATIONS.—Section

20 1819(g)(1)(C) (42 U.S.C. 1395i–3(g)(1)(C)) is

21 amended by striking the second sentence and

22 inserting the following: ‘‘The State shall, after

23 providing the individual involved with a written

24 notice of the allegations (including a statement

25 of the availability of a hearing for the individual
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1 to rebut the allegations) and the opportunity

2 for a hearing on the record, make a written

3 finding as to the accuracy of the allegations.’’.

4 (C) EFFECTIVE DATE.—The amendments

5 made by this paragraph shall take effect Janu6 ary 1, 1995.

7 (d) CORRECTIONS RELATING TO SECTION 4008.—

8 (1) Section 1819(b)(5)(D) (42 U.S.C. 1395i–

9 3(b)(5)(D)), as amended by section 4008(h)(1)(D)

10 of OBRA–1990, is amended by striking the comma

11 before ‘‘or a new competency evaluation program.’’.

12 (2) Section 1819(b)(5)(G) (42 U.S.C. 1395i–

13 3(b)(5)(G)) is amended by striking ‘‘or licensed or

14 certified social worker’’ and inserting ‘‘licensed or

15 certified social worker, registered respiratory thera16 pist, or certified respiratory therapy technician’’.

17 (3) Section 1819(f)(2)(B)(i) (42 U.S.C. 1395i–

18 3(f)(2)(B)(i)) is amended by striking ‘‘facilities,’’

19 and inserting ‘‘facilities (subject to clause (iii)),’’.

20 (4) Section 1819(f)(2)(B)(iii)(I)(c) (42 U.S.C.

21 1395i–3(f)(2)(B)(iii)(I)(c)) is amended by striking

22 ‘‘clauses’’ each place it appears and inserting

23 ‘‘clause’’.
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1 (5) Section 1819(g)(5)(B) (42 U.S.C. 1395i–

2 3(g)(5)(B)) is amended by striking ‘‘paragraphs’’

3 and inserting ‘‘paragraph’’.

4 (6) Section 4008(h)(1)(F)(ii) of OBRA–1990 is

5 amended—

6 (A) by striking ‘‘The amendments’’ and in7 serting ‘‘(I) The amendments’’;

8 (B) by striking ‘‘nursing facility’’ each

9 place it appears and inserting ‘‘skilled nursing

10 facility’’;

11 (C) by redesignating subclauses (I)

12 through (V) as items (aa) through (ee); and

13 (D) by adding at the end the following new

14 subclause:

15 ‘‘(II) Notwithstanding subclause (I)

16 and subject to section 1819(f)(2)(B)(iii)(I)

17 of the Social Security Act (as amended by

18 clause (i)), a State may approve a training

19 and competency evaluation program or a

20 competency evaluation program offered by

21 or in a skilled nursing facility described in

22 subclause (I) if, during the previous 2

23 years, item (aa), (bb), (cc), (dd), or (ee) of

24 subclause (I) did not apply to the facil25 ity.’’.
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1 (7) EFFECTIVE DATE.—The amendments made

2 by this subsection shall take effect as if included in

3 the enactment of OBRA–1990.

4 SEC. 107. NOTIFICATION OF AVAILABILITY OF HOSPICE

5 BENEFIT.

6 (a) IN GENERAL.—Section 1861(ee)(2)(D) (42

7 U.S.C. 1395x(ee)(2)(D)) is amended by inserting ‘‘, in8 cluding hospice services,’’ after ‘‘post-hospital services’’.

9 (b) EFFECTIVE DATE.—The amendment made by

10 subsection (a) shall apply to services furnished on or after

11 the first day of the first month beginning more than one

12 year after the date of the enactment of this Act.

13 SEC. 108. CLARIFYING EXPERTISE OF INDIVIDUALS TO

14 SERVE ON THE PROSPECTIVE PAYMENT AS15 SESSMENT COMMISSION.

16 Section 1886(e)(6)(B) (42 U.S.C. 1395ww(e)(6)(B))

17 is amended by striking ‘‘hospital reimbursement, hospital

18 financial management’’ and inserting ‘‘health facility man19 agement, reimbursement of health facilities or other pro20 viders of services which reflect the scope of the Commis21 sion’s responsibilities’’.
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1 SEC. 109. AUTHORITY FOR BUDGET NEUTRAL ADJUST2 MENTS FOR CHANGES IN PAYMENT AMOUNTS

3 FOR TRANSFER CASES.

4 Section 1886(d)(5)(I) (42 U.S.C. 1395ww(d)(5)) is

5 amended—

6 (1) by inserting ‘‘(i)’’ after ‘‘(I)’’; and

7 (2) by adding at the end the following new

8 clause:

9 ‘‘(ii) In making adjustments under clause (i) for

10 transfer cases (as defined by the Secretary) in a fiscal

11 year, the Secretary may make adjustments to each of the

12 average standardized amounts determined under para13 graph (3) to assure that the aggregate payments made

14 under this subsection for such fiscal year are not greater

15 or lesser than those that would have otherwise been made

16 in such fiscal year.’’.

17 SEC. 110. CLARIFICATION OF DRG PAYMENT WINDOW EX18 PANSION; MISCELLANEOUS AND TECHNICAL

19 CORRECTIONS.

20 (a) CLARIFICATION OF DRG PAYMENT WINDOW EX21 PANSION.—The first sentence of section 1886(a)(4) (42

22 U.S.C. 1395ww(a)(4)) is amended by inserting ‘‘(or, in the

23 case of a hospital that is not a subsection (d) hospital,

24 during the 1 day)’’ after ‘‘3 days’’.

25 (b) TECHNICAL CORRECTION RELATING TO RESI26 DENT ASSESSMENT IN NURSING HOMES.—Section
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1 1819(b)(3)(C)(i)(I) (42 U.S.C. 1395i–3(b)(3)(C)(i)(I)) is

2 amended by striking ‘‘not later than’’ before ‘‘14 days’’.

3 (c) TECHNICAL CORRECTION RELATING TO APPLICA4 BLE ADJUSTMENT FACTOR FOR INDIRECT MEDICAL

5 EDUCATION ADJUSTMENT.—Section 1886(d)(5)(B)(ii)

6 (42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended by striking

7 ‘‘May 1, 1986,’’ and inserting ‘‘October 1, 1988,’’.

8 (d) CLERICAL CORRECTIONS.—(1) Section

9 1814(i)(1)(C)(i) (42 U.S.C. 1395f(i)(1)(C)(i)) is amended

10 by striking ‘‘September 30, 1990,,’’ and inserting ‘‘Sep11 tember 30, 1990,’’.

12 (2) Section 1816(f)(2)(A)(ii) (42 U.S.C.

13 1396h(f)(2)(A)(ii)) is amended by striking ‘‘such agency’’

14 and inserting ‘‘such agency’s’’.

15 Subtitle B—Provisions Relating to

16 Part B

17 PART I—PHYSICIANS’ SERVICES

18 SEC. 121. DEVELOPMENT AND IMPLEMENTATION OF RE19 SOURCE-BASED METHODOLOGY FOR PRAC20 TICE EXPENSES.

21 (a) DEVELOPMENT.—

22 (1) IN GENERAL.—The Secretary of Health and

23 Human Services shall develop a methodology for im24 plementing in 1998 a resource-based system for de25 termining practice expense relative value units for
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1 each physicians’ service. The methodology utilized

2 shall recognize the staff, equipment, and supplies

3 used in the provision of various medical and surgical

4 services in various settings.

5 (2) REPORT.—The Secretary shall transmit a

6 report by June 30, 1996, on the methodology devel7 oped under paragraph (1) to the Committees on

8 Ways and Means and Energy and Commerce of the

9 House of Representatives and the Committee on Fi10 nance of the Senate. The report shall include a pres11 entation of data utilized in developing the methodol12 ogy and an explanation of the methodology.

13 (b) IMPLEMENTATION.—

14 (1) IN GENERAL.—Section 1848(c)(2)(C)(ii)

15 (42 U.S.C. 1395w–4(c)(2)(C)(ii)) is amended—

16 (A) by inserting ‘‘for the service for years

17 before 1998’’ before ‘‘equal to’’,

18 (B) by striking the period at the end of

19 subclause (II) and inserting a comma, and

20 (C) by adding after and below subclause

21 (II) the following:

22 ‘‘and for years beginning with 1998 based

23 on the relative practice expense resources

24 involved in furnishing the service.’’.
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1 (2) CONFORMING AMENDMENT.—Section

2 1848(c)(3)(C)(ii) (42 U.S.C. 1395w–4(c)(3)(C)(ii))

3 is amended by striking ‘‘The practice’’ and inserting

4 ‘‘For years before 1998, the practice’’.

5 (3) APPLICATION OF CERTAIN PROVISIONS.—In

6 implementing the amendment made by paragraph

7 (1)(C), the provisions of clauses (ii)(II) and (iii) of

8 section 1848(c)(2)(B) of the Social Security Act

9 shall apply in the same manner as they apply to ad10 justments under clause (ii)(I) of such section.

11 SEC. 122. GEOGRAPHIC COST OF PRACTICE INDEX REFINE12 MENTS.

13 (a) REQUIRING CONSULTATION WITH REPRESENTA14 TIVES OF PHYSICIANS IN REVIEWING GEOGRAPHIC AD15 JUSTMENT FACTORS.—Section 1848(e)(1)(C) (42 U.S.C.

16 1395w–4(e)(1)(C)) is amended by striking ‘‘shall review’’

17 and inserting ‘‘shall, in consultation with appropriate rep18 resentatives of physicians, review’’.

19 (b) USE OF MOST RECENT DATA IN GEOGRAPHIC

20 ADJUSTMENT.—Section 1848(e)(1) (42 U.S.C. 1395w–

21 4(e)(1)) is amended by adding at the end the following

22 new subparagraph:

23 ‘‘(D) USE OF RECENT DATA.—In estab24 lishing indices and index values under this

25 paragraph, the Secretary shall use the most re-
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1 cent data available relating to practice ex2 penses, malpractice expenses, and physician

3 work effort in different fee schedule areas.’’.

4 (c) REPORT ON REVIEW PROCESS.—Not later than

5 1 year after the date of the enactment of this Act, the

6 Secretary of Health and Human Services shall study and

7 report to the Committee on Finance of the Senate and

8 the Committee on Ways and Means and the Committee

9 on Energy and Commerce of the House of Representatives

10 on—

11 (1) the data necessary to review and revise the

12 indices established under section 1848(e)(1)(A) of

13 the Social Security Act, including—

14 (A) the shares allocated to physicians’

15 work effort, practice expenses (other than mal16 practice expenses), and malpractice expenses;

17 (B) the weights assigned to the input com18 ponents of such shares; and

19 (C) the index values assigned to such com20 ponents;

21 (2) any limitations on the availability of data

22 necessary to review and revise such indices at least

23 every three years;

24 (3) ways of addressing such limitations, with

25 particular attention to the development of alternative
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1 data sources for input components for which current

2 index values are based on data collected less fre3 quently than every three years; and

4 (4) the costs of developing more accurate and

5 timely data.

6 SEC. 123. EXTRA-BILLING LIMITS.

7 (a) ENFORCEMENT OF LIMITS.—Section 1848(g) (42

8 U.S.C. 1395w–4(g)), as amended by section 13517(a) of

9 OBRA–1993, is amended—

10 (1) by amending paragraph (1) to read as fol11 lows:

12 ‘‘(1) LIMITATION ON ACTUAL CHARGES.—

13 ‘‘(A) IN GENERAL.—In the case of a

14 nonparticipating physician or nonparticipating

15 supplier or other person (as defined in section

16 1842(i)(2)) who does not accept payment on an

17 assignment-related basis for a physician’s serv18 ice furnished with respect to an individual en19 rolled under this part, the following rules apply:

20 ‘‘(i) APPLICATION OF LIMITING

21 CHARGE.—No person may bill or collect an

22 actual charge for the service in excess of

23 the limiting charge described in paragraph

24 (2) for such service.
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1 ‘‘(ii) NO LIABILITY FOR EXCESS

2 CHARGES.—No person is liable for pay3 ment of any amounts billed for the service

4 in excess of such limiting charge.

5 ‘‘(iii) CORRECTION OF EXCESS

6 CHARGES.—If such a physician, supplier,

7 or other person bills, but does not collect,

8 an actual charge for a service in violation

9 of clause (i), the physician, supplier, or

10 other person shall reduce on a timely basis

11 the actual charge billed for the service to

12 an amount not to exceed the limiting

13 charge for the service.

14 ‘‘(iv) REFUND OF EXCESS COLLEC15 TIONS.—If such a physician, supplier, or

16 other person collects an actual charge for

17 a service in violation of clause (i), the phy18 sician, supplier, or other person shall pro19 vide on a timely basis a refund to the indi20 vidual charged in the amount by which the

21 amount collected exceeded the limiting

22 charge for the service. The amount of such

23 a refund shall be reduced to the extent the

24 individual has an outstanding balance owed

25 by the individual to the physician.
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1 ‘‘(B) SANCTIONS.—If a physician, supplier,

2 or other person—

3 ‘‘(i) knowingly and willfully bills or

4 collects for services in violation of subpara5 graph (A)(i) on a repeated basis, or

6 ‘‘(ii) fails to comply with clause (iii)

7 or (iv) of subparagraph (A) on a timely

8 basis,

9 the Secretary may apply sanctions against the

10 physician, supplier, or other person in accord11 ance with paragraph (2) of section 1842(j). In

12 applying this subparagraph, paragraph (4) of

13 such section applies in the same manner as

14 such paragraph applies to such section and any

15 reference in such section to a physician is

16 deemed also to include a reference to a supplier

17 or other person under this subparagraph.

18 ‘‘(C) TIMELY BASIS.—For purposes of this

19 paragraph, a correction of a bill for an excess

20 charge or refund of an amount with respect to

21 a violation of subparagraph (A)(i) in the case of

22 a service is considered to be provided ‘on a

23 timely basis’, if the reduction or refund is made

24 not later than 30 days after the date the physi25 cian, supplier, or other person is notified by the
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1 carrier under this part of such violation and of

2 the requirements of subparagraph (A).’’; and

3 (2) in paragraph (3)(B)—

4 (A) by inserting after the first sentence the

5 following: ‘‘No person is liable for payment of

6 any amounts billed for such a service in viola7 tion of the previous sentence.’’, and

8 (B) in the last sentence, by striking ‘‘pre9 vious sentence’’ and inserting ‘‘first sentence’’.

10 (b) CLARIFICATION OF MANDATORY ASSIGNMENT

11 RULES FOR CERTAIN PRACTITIONERS.—

12 (1) IN GENERAL.—Section 1842(b) (42 U.S.C.

13 1395u(b)), as amended by section 126(e), is amend14 ed by adding at the end the following new para15 graph:

16 ‘‘(18)(A) Payment for any service furnished by a

17 practitioner described in subparagraph (C) and for which

18 payment may be made under this part on a reasonable

19 charge or fee schedule basis may only be made under this

20 part on an assignment-related basis.

21 ‘‘(B) A practitioner described in subparagraph (C) or

22 other person may not bill (or collect any amount from)

23 the individual or another person for any service described

24 in subparagraph (A), except for deductible and coinsur25 ance amounts applicable under this part. No person is lia-
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1 ble for payment of any amounts billed for such a service

2 in violation of the previous sentence. If a practitioner or

3 other person knowingly and willfully bills (or collects an

4 amount) for such a service in violation of such sentence,

5 the Secretary may apply sanctions against the practitioner

6 or other person in the same manner as the Secretary may

7 apply sanctions against a physician in accordance with

8 subsection (j)(2) in the same manner as such section ap9 plies with respect to a physician. Paragraph (4) of sub10 section (j) shall apply in this subparagraph in the same

11 manner as such paragraph applies to such section.

12 ‘‘(C) A practitioner described in this subparagraph

13 is any of the following:

14 ‘‘(i) A physician assistant, nurse practitioner, or

15 clinical nurse specialist (as defined in section

16 1861(aa)(5)).

17 ‘‘(ii) A certified registered nurse anesthetist (as

18 defined in section 1861(bb)(2)).

19 ‘‘(iii) A certified nurse-midwife (as defined in

20 section 1861(gg)(2)).

21 ‘‘(iv) A clinical social worker (as defined in sec22 tion 1861(hh)(1)).

23 ‘‘(v) A clinical psychologist (as defined by the

24 Secretary for purposes of section 1861(ii)).
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1 ‘‘(D) For purposes of this paragraph, a service fur2 nished by a practitioner described in subparagraph (C) in3 cludes any services and supplies furnished as incident to

4 the service as would otherwise be covered under this part

5 if furnished by a physician or as incident to a physician’s

6 service.’’.

7 (2) CONFORMING AMENDMENTS.—

8 (A) Section 1833 (42 U.S.C. 1395l) is

9 amended—

10 (i) in subsection (l)(5), by striking

11 subparagraph (B) and redesignating sub12 paragraph (C) as subparagraph (B);

13 (ii) by striking subsection (p); and

14 (iii) in subsection (r), by striking

15 paragraph (3) and redesignating para16 graph (4) as paragraph (3).

17 (B) Section 1842(b)(12) (42 U.S.C.

18 1395u(b)(12)) is amended by striking subpara19 graph (C).

20 (c) INFORMATION ON EXTRA-BILLING LIMITS.—

21 (1) PART OF EXPLANATION OF MEDICARE BEN22 EFITS.—Section 1842(h)(7) (42 U.S.C.

23 1395u(h)(7)) is amended—

24 (A) by striking ‘‘and’’ at the end of sub25 paragraph (B),
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1 (B) in subparagraph (C), by striking ‘‘shall

2 include’’,

3 (C) in subparagraph (C), by striking the

4 period at the end and inserting ‘‘, and’’, and

5 (D) by adding at the end the following new

6 subparagraph:

7 ‘‘(D) in the case of services for which the billed

8 amount exceeds the limiting charge imposed under

9 section 1848(g), information regarding such applica10 ble limiting charge (including information concern11 ing the right to a refund under section

12 1848(g)(1)(A)(iv)).’’.

13 (2) DETERMINATIONS BY CARRIERS.—Subpara14 graph (G) of section 1842(b)(3) (42 U.S.C.

15 1395u(b)(3)) is amended to read as follows:

16 ‘‘(G) will, for a service that is furnished with

17 respect to an individual enrolled under this part,

18 that is not paid on an assignment-related basis, and

19 that is subject to a limiting charge under section

20 1848(g)—

21 ‘‘(i) determine, prior to making payment,

22 whether the amount billed for such service ex23 ceeds the limiting charge applicable under sec24 tion 1848(g)(2);
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1 ‘‘(ii) notify the physician, supplier, or other

2 person periodically (but not less often than once

3 every 30 days) of determinations that amounts

4 billed exceeded such applicable limiting charges;

5 and

6 ‘‘(iii) provide for prompt response to in7 quiries of physicians, suppliers, and other per8 sons concerning the accuracy of such limiting

9 charges for their services;’’.

10 (d) REPORT ON CHARGES IN EXCESS OF LIMITING

11 CHARGE.—Section 1848(g)(6)(B) (42 U.S.C. 1395w–

12 4(g)(6)(B)) is amended by inserting ‘‘information on the

13 extent to which actual charges exceed limiting charges, the

14 number and types of services involved, and the average

15 amount of excess charges and information’’ after ‘‘report

16 to the Congress’’.

17 (e) MISCELLANEOUS AND TECHNICAL AMEND18 MENTS.—Section 1833(h)(5)(D) (42 U.S.C.

19 1395l(h)(5)(D)) is amended—

20 (1) by striking ‘‘paragraphs (2) and (3)’’ and

21 by inserting ‘‘paragraph (2)’’; and

22 (2) by adding at the end the following: ‘‘Para23 graph (4) of such section shall apply in this sub24 paragraph in the same manner as such paragraph

25 applies to such section.’’.
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1 (f) EFFECTIVE DATES.—

2 (1) ENFORCEMENT; MISCELLANEOUS AND

3 TECHNICAL AMENDMENTS.—The amendments made

4 by subsections (a) and (e) shall apply to services fur5 nished on or after the date of the enactment of this

6 Act; except that the amendments made by sub7 section (a) shall not apply to services of a

8 nonparticipating supplier or other person furnished

9 before January 1, 1995.

10 (2) PRACTITIONERS.—The amendments made

11 by subsection (b) shall apply to services furnished on

12 or after January 1, 1995.

13 (3) EOMBS.—The amendments made by sub14 section (c)(1) shall apply to explanations of benefits

15 provided on or after July 1, 1995.

16 (4) CARRIER DETERMINATIONS.—The amend17 ments made by subsection (c)(2) shall apply to con18 tracts as of January 1, 1995.

19 (5) REPORT.—The amendment made by sub20 section (d) shall apply to reports for years beginning

21 with 1995.

22 SEC. 124. RELATIVE VALUES FOR PEDIATRIC SERVICES.

23 (a) IN GENERAL.—The Secretary of Health and

24 Human Services shall fully develop, by not later than July

25 1, 1995, relative values for the full range of pediatric phy-
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1 sicians’ services which are consistent with the relative val2 ues developed for other physicians’ services under section

3 1848(c) of the Social Security Act. In developing such val4 ues, the Secretary shall conduct such refinements as may

5 be necessary to produce appropriate estimates for such rel6 ative values.

7 (b) STUDY.—

8 (1) IN GENERAL.—The Secretary shall conduct

9 a study of the relative values for pediatric and other

10 services to determine whether there are significant

11 variations in the resources used in providing similar

12 services to different populations. In conducting such

13 study, the Secretary shall consult with appropriate

14 organizations representing pediatricians and other

15 physicians and physical and occupational therapists.

16 (2) REPORT.—Not later than July 1, 1995, the

17 Secretary shall submit to Congress a report on the

18 study conducted under paragraph (1). Such report

19 shall include any appropriate recommendations re20 garding needed changes in coding or other payment

21 policies to ensure that payments for pediatric serv22 ices appropriately reflect the resources required to

23 provide these services.
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1 SEC. 125. ADMINISTRATION OF CLAIMS RELATING TO PHY2 SICIANS’ SERVICES.

3 (a) LIMITATION ON CARRIER USER FEES.—Section

4 1842(c) (42 U.S.C. 1395u(c)) is amended by adding at

5 the end the following new paragraph:

6 ‘‘(4) Neither a carrier nor the Secretary may impose

7 a fee under this title—

8 ‘‘(A) for the filing of claims related to physi9 cians’ services,

10 ‘‘(B) for an error in filing a claim relating to

11 physicians’ services or for such a claim which is de12 nied,

13 ‘‘(C) for any appeal under this title with respect

14 to physicians’ services,

15 ‘‘(D) for applying for (or obtaining) a unique

16 identifier under subsection (r), or

17 ‘‘(E) for responding to inquiries respecting phy18 sicians’ services or for providing information with re19 spect to medical review of such services.’’.

20 (b) CLARIFICATION OF PERMISSIBLE SUBSTITUTE

21 BILLING ARRANGEMENTS.—

22 (1) IN GENERAL.—Clause (D) of section

23 1842(b)(6) (42 U.S.C. 1395u(b)(6)) is amended to

24 read as follows: ‘‘(D) payment may be made to a

25 physician for physicians’ services (and services fur26 nished incident to such services) furnished by a sec-
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1 ond physician to patients of the first physician if (i)

2 the first physician is unavailable to provide the serv3 ices; (ii) the services are furnished pursuant to an

4 arrangement between the two physicians that (I) is

5 informal and reciprocal, or (II) involves per diem or

6 other fee-for-time compensation for such services;

7 (iii) the services are not provided by the second phy8 sician over a continuous period of more than 60

9 days; and (iv) the claim form submitted to the car10 rier for such services includes the second physician’s

11 unique identifier (provided under the system estab12 lished under subsection (r)) and indicates that the

13 claim meets the requirements of this subparagraph

14 for payment to the first physician’’.

15 (2) EFFECTIVE DATE.—The amendment made

16 by paragraph (1) shall apply to services furnished on

17 or after the first day of the first month beginning

18 more than 60 days after the date of the enactment

19 of this Act.

20 SEC. 126. MISCELLANEOUS AND TECHNICAL CORRECTIONS.

21 (a) OVERVALUED PROCEDURES.—(1) Section

22 1842(b)(16)(B)(iii) (42 U.S.C. 1395u(b)(16)(B)(iii)) is

23 amended—

24 (A) by striking ‘‘, simple and subcutaneous’’,
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1 (B) by striking ‘‘; small’’ and inserting ‘‘and

2 small’’,

3 (C) by striking ‘‘treatments;’’ the first place it

4 appears and inserting ‘‘and’’,

5 (D) by striking ‘‘lobectomy;’’,

6 (E) by striking ‘‘enterectomy; colectomy; chole7 cystectomy;’’,

8 (F) by striking ‘‘; transurerethral resection’’

9 and inserting ‘‘and resection’’, and

10 (G) by striking ‘‘sacral laminectomy;’’.

11 (2) Section 4101(b)(2) of OBRA–1990 is amended—

12 (A) in the matter before subparagraph (A), by

13 striking ‘‘1842(b)(16)’’ and inserting

14 ‘‘1842(b)(16)(B)’’, and

15 (B) in subparagraph (B)—

16 (i) by striking ‘‘, simple and subcutane17 ous’’,

18 (ii) by striking ‘‘(HCPCS codes 19160 and

19 19162)’’ and inserting ‘‘(HCPCS code 19160)’’,

20 and

21 (iii) by striking all that follows ‘‘(HCPCS

22 codes 92250’’ and inserting ‘‘and 92260).’’.

23 (b) RADIOLOGY SERVICES.—(1) Section 1834(b)(4)

24 (42 U.S.C. 1395m(b)(4)) is amended by redesignating the

25 subparagraphs (E) and (F) redesignated by section
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1 4102(a)(1) of OBRA–1990 as subparagraphs (F) and

2 (G), respectively.

3 (2) Section 1834(b)(4)(D) (42 U.S.C.

4 1395m(b)(4)(D)) is amended—

5 (A) in the matter before clause (i), by striking

6 ‘‘shall be determined as follows:’’ and inserting

7 ‘‘shall, subject to clause (vii), be reduced to the ad8 justed conversion factor for the locality determined

9 as follows:’’,

10 (B) in clause (iv), by striking ‘‘LOCAL ADJUST11 MENT.—Subject to clause (vii), the conversion factor

12 to be applied to’’ and inserting ‘‘ADJUSTED CONVER13 SION FACTOR.—The adjusted conversion factor for’’,

14 (C) in clause (vii), by striking ‘‘under this sub15 paragraph’’, and

16 (D) in clause (vii), by inserting ‘‘reduced under

17 this subparagraph by’’ after ‘‘shall not be’’.

18 (3) Section 4102(c)(2) of OBRA–1990 is amended

19 by striking ‘‘radiology services’’ and all that follows and

20 inserting ‘‘nuclear medicine services.’’.

21 (4) Section 4102(d) of OBRA–1990 is amended by

22 striking ‘‘new paragraph’’ and inserting ‘‘new subpara23 graph’’.
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1 (5) Section 1834(b)(4)(E) (42 U.S.C.

2 1395m(b)(4)(E)) is amended by inserting ‘‘RULE FOR

3 CERTAIN SCANNING SERVICES.—’’ after ‘‘(E)’’.

4 (6) Section 1848(a)(2)(D)(iii) (42 U.S.C. 1395w–

5 4(a)(2)(D)(iii)) is amended by striking ‘‘that are subject

6 to section 6105(b) of the Omnibus Budget Reconciliation

7 Act of 1989’’ and by striking ‘‘provided under such sec8 tion’’ and inserting ‘‘provided under section 6105(b) of the

9 Omnibus Budget Reconciliation Act of 1989’’.

10 (c) ANESTHESIA SERVICES.—(1) Section 4103(a) of

11 OBRA–1990 is amended by striking ‘‘REDUCTION IN FEE

12 SCHEDULE’’ and inserting ‘‘REDUCTION IN PREVAILING

13 CHARGES’’.

14 (2) Section 1842(q)(1)(B) (42 U.S.C.

15 1395u(q)(1)(B)) is amended—

16 (A) in the matter before clause (i), by striking

17 ‘‘shall be determined as follows:’’ and inserting

18 ‘‘shall, subject to clause (iv), be reduced to the ad19 justed prevailing charge conversion factor for the lo20 cality determined as follows:’’, and

21 (B) in clause (iii), by striking ‘‘Subject to

22 clause (iv), the prevailing charge conversion factor to

23 be applied in’’ and inserting ‘‘The adjusted prevail24 ing charge conversion factor for’’.
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1 (d) ASSISTANTS AT SURGERY.—(1) Section 4107(c)

2 of OBRA–1990 is amended by inserting ‘‘(a)(1)’’ after

3 ‘‘subsection’’.

4 (2) Section 4107(a)(2) of OBRA–1990 is amended

5 by adding at the end the following: ‘‘In applying section

6 1848(g)(2)(D) of the Social Security Act for services of

7 an assistant-at-surgery furnished during 1991, the recog8 nized payment amount shall not exceed the maximum

9 amount specified under section 1848(i)(2)(A) of such Act

10 (as applied under this paragraph in such year).’’.

11 (e) TECHNICAL COMPONENTS OF DIAGNOSTIC SERV12 ICES.—Section 1842(b) (42 U.S.C. 1395u(b)) is amended

13 by redesignating paragraph (18), as added by section

14 4108(a) of OBRA–1990, as paragraph (17) and, in such

15 paragraph, by inserting ‘‘, tests specified in paragraph

16 (14)(C)(i),’’ after ‘‘diagnostic laboratory tests’’.

17 (f) STATEWIDE FEE SCHEDULES.—Section 4117 of

18 OBRA–1990 is amended—

19 (1) in subsection (a)—

20 (A) by striking ‘‘(a) IN GENERAL.—’’, and

21 (B) by striking ‘‘, if the’’ and all that fol22 lows through ‘‘1991,’’; and

23 (2) by striking subsections (b), (c), and (d).
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1 (g) OTHER MISCELLANEOUS AND TECHNICAL

2 AMENDMENTS.—(1) The heading of section 1834(f) (42

3 U.S.C. 1395m(f)) is amended by striking ‘‘FISCAL YEAR’’.

4 (2)(A) Section 4105(b) of OBRA–1990 is amended—

5 (i) in paragraph (2), by striking ‘‘amendments’’

6 and inserting ‘‘amendment’’, and

7 (ii) in paragraph (3), by striking ‘‘amendments

8 made by paragraphs (1) and (2)’’ and inserting

9 ‘‘amendment made by paragraph (1)’’.

10 (B) Section 1848(f)(2)(C) (42 U.S.C. 1395w–

11 4(f)(2)(C)) is amended by inserting ‘‘PERFORMANCE

12 STANDARD RATES OF INCREASE FOR FISCAL YEAR

13 1991.—’’ after ‘‘(C)’’.

14 (C) Section 4105(d) of OBRA–1990 is amended by

15 inserting ‘‘PUBLICATION OF PERFORMANCE STANDARD

16 RATES.—’’ after ‘‘(d)’’.

17 (3) Section 4106(c) of OBRA–1990 is amended by

18 inserting ‘‘of the Social Security Act’’ after

19 ‘‘1848(d)(1)(B)’’.

20 (4) Section 4114 of OBRA–1990 is amended by

21 striking ‘‘patients’’ the second place it appears.

22 (5) Section 1848(e)(1)(C) (42 U.S.C. 1395w–

23 4(e)(1)(C)) is amended by inserting ‘‘date of the’’ after

24 ‘‘since the’’.
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1 (6) Section 4118(f)(1)(D) of OBRA–1990 is amend2 ed by striking ‘‘is amended’’.

3 (7) Section 4118(f)(1)(N)(ii) of OBRA–1990 is

4 amended by striking ‘‘subsection (f)(5)(A)’’ and inserting

5 ‘‘subsection (f)(5)(A))’’.

6 (8) Section 1845(e) (42 U.S.C. 1395w–1(e)) is

7 amended—

8 (A) by striking paragraph (2); and

9 (B) by redesignating paragraphs (3), (4), and

10 (5) as paragraphs (2), (3), and (4).

11 (9) Section 4118(j)(2) of OBRA–1990 is amended by

12 striking ‘‘In section’’ and inserting ‘‘Section’’.

13 (10)(A) Section 1848(i)(3) (42 U.S.C. 1395w–

14 4(i)(3)) is amended by striking the space before the period

15 at the end.

16 (B) Section 1834(a)(10)(B) (42 U.S.C.

17 1395m(a)(10)(B)) is amended—

18 (i) by striking ‘‘apply to’’ and inserting ‘‘would

19 otherwise apply to’’, and

20 (ii) by inserting before the period at the end

21 ‘‘but for the application of section 1848(i)(3)’’.

22 (h) OTHER CORRECTIONS.—(1) Effective on the date

23 of the enactment of this Act, section 6102(d)(4) of

24 OBRA–1989 is amended by striking all that follows the

25 first sentence.
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1 (2) Effective for payments for fiscal years beginning

2 with fiscal year 1994, section 1842(c)(1) (42 U.S.C.

3 1395u(c)(1)) is amended—

4 (A) in subparagraph (A), by striking ‘‘(A) Any

5 contract’’ and inserting ‘‘Any contract’’; and

6 (B) by striking subparagraph (B).

7 (i) EFFECTIVE DATE.—Except as provided in sub8 section (i), the amendments made by this section and the

9 provisions of this section shall take effect as if included

10 in the enactment of OBRA–1990.

11 PART II—DURABLE MEDICAL EQUIPMENT

12 SEC. 131. CERTIFICATION OF SUPPLIERS.

13 (a) REQUIREMENTS.—

14 (1) IN GENERAL.—Section 1834 (42 U.S.C.

15 1395m), as amended by section 13544(b)(1) of

16 OBRA–1993, is amended by adding at the end the

17 following new subsection:

18 ‘‘(j) REQUIREMENTS FOR SUPPLIERS OF MEDICAL

19 EQUIPMENT AND SUPPLIES.—

20 ‘‘(1) ISSUANCE AND RENEWAL OF SUPPLIER

21 NUMBER.—

22 ‘‘(A) PAYMENT.—Except as provided in

23 subparagraph (C), no payment may be made

24 under this part after the date of the enactment

25 of the Social Security Act Amentments of 1994
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1 for items furnished by a supplier of medical

2 equipment and supplies unless such supplier ob3 tains (and renews at such intervals as the Sec4 retary may require) a supplier number.

5 ‘‘(B) STANDARDS FOR POSSESSING A SUP6 PLIER NUMBER.—A supplier may not obtain a

7 supplier number unless—

8 ‘‘(i) for medical equipment and sup9 plies furnished on or after the date of en10 actment of the Social Security Act Amend11 ments of 1994, and before January 1,

12 1996, the supplier meets standards pre13 scribed by the Secretary in regulations is14 sued on June 18, 1992; and

15 ‘‘(ii) for medical equipment and sup16 plies furnished on or after January 1,

17 1996, the supplier meets revised standards

18 prescribed by the Secretary (in consulta19 tion with representatives of suppliers of

20 medical equipment and supplies, carriers,

21 and consumers) that shall include require22 ments that the supplier—

23 ‘‘(I) comply with all applicable

24 State and Federal licensure and regu25 latory requirements;
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1 ‘‘(II) maintain a physical facility

2 on an appropriate site;

3 ‘‘(III) have proof of appropriate

4 liability insurance; and

5 ‘‘(IV) meet such other require6 ments as the Secretary may specify.

7 ‘‘(C) EXCEPTION FOR ITEMS FURNISHED

8 AS INCIDENT TO A PHYSICIAN’S SERVICE.—

9 Subparagraph (A) shall not apply with respect

10 to medical equipment and supplies furnished in11 cident to a physician’s service.

12 ‘‘(D) PROHIBITION AGAINST MULTIPLE

13 SUPPLIER NUMBERS.—The Secretary may not

14 issue more than one supplier number to any

15 supplier of medical equipment and supplies un16 less the issuance of more than one number is

17 appropriate to identify subsidiary or regional

18 entities under the supplier’s ownership or con19 trol.

20 ‘‘(E) PROHIBITION AGAINST DELEGATION

21 OF SUPPLIER DETERMINATIONS.—The Sec22 retary may not delegate (other than by contract

23 under section 1842) the responsibility to deter24 mine whether suppliers meet the standards nec25 essary to obtain a supplier number.
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1 ‘‘(2) CERTIFICATES OF MEDICAL NECESSITY.—

2 ‘‘(A) LIMITATION ON INFORMATION PRO3 VIDED BY SUPPLIERS ON CERTIFICATES OF

4 MEDICAL NECESSITY.—

5 ‘‘(i) IN GENERAL.—Effective 60 days

6 after the date of enactment of the Social

7 Security Act Amendments of 1994, a sup8 plier of medical equipment and supplies

9 may distribute to physicians, or to individ10 uals entitled to benefits under this part, a

11 certificate of medical necessity for commer12 cial purposes which contains no more than

13 the following information completed by the

14 supplier:

15 ‘‘(I) An identification of the sup16 plier and the beneficiary to whom

17 such medical equipment and supplies

18 are furnished.

19 ‘‘(II) A description of such medi20 cal equipment and supplies.

21 ‘‘(III) Any product code identify22 ing such medical equipment and sup23 plies.

24 ‘‘(IV) Any other administrative

25 information (other than information
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1 relating to the beneficiary’s medical

2 condition) identified by the Secretary.

3 ‘‘(ii) INFORMATION ON PAYMENT

4 AMOUNT AND CHARGES.—If a supplier dis5 tributes a certificate of medical necessity

6 containing any of the information per7 mitted to be supplied under clause (i), the

8 supplier shall also list on the certificate of

9 medical necessity the fee schedule amount

10 and the supplier’s charge for the medical

11 equipment or supplies being furnished

12 prior to distribution of such certificate to

13 the physician.

14 ‘‘(iii) PENALTY.—Any supplier of

15 medical equipment and supplies who know16 ingly and willfully distributes a certificate

17 of medical necessity in violation of clause

18 (i) or fails to provide the information re19 quired under clause (ii) is subject to a civil

20 money penalty in an amount not to exceed

21 $1,000 for each such certificate of medical

22 necessity so distributed. The provisions of

23 section 1128A (other than subsections (a)

24 and (b)) shall apply to civil money pen25 alties under this subparagraph in the same
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1 manner as they apply to a penalty or pro2 ceeding under section 1128A(a).

3 ‘‘(B) DEFINITION.—For purposes of this

4 paragraph, the term ‘certificate of medical ne5 cessity’ means a form or other document con6 taining information required by the carrier to

7 be submitted to show that an item is reasonable

8 and necessary for the diagnosis or treatment of

9 illness or injury or to improve the functioning

10 of a malformed body member.

11 ‘‘(3) COVERAGE AND REVIEW CRITERIA.—The

12 Secretary shall annually review the coverage and uti13 lization of items of medical equipment and supplies

14 to determine whether such items should be made

15 subject to coverage and utilization review criteria,

16 and if appropriate, shall develop and apply such cri17 teria to such items.

18 ‘‘(4) DEFINITION.—The term ‘medical equip19 ment and supplies’ means—

20 ‘‘(A) durable medical equipment (as de21 fined in section 1861(n));

22 ‘‘(B) prosthetic devices (as described in

23 section 1861(s)(8));

24 ‘‘(C) orthotics and prosthetics (as de25 scribed in section 1861(s)(9));
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1 ‘‘(D) surgical dressings (as described in

2 section 1861(s)(5));

3 ‘‘(E) such other items as the Secretary

4 may determine; and

5 ‘‘(F) for purposes of paragraphs (1) and

6 (3)—

7 ‘‘(i) home dialysis supplies and equip8 ment (as described in section

9 1861(s)(2)(F)),

10 ‘‘(ii) immunosuppressive drugs (as de11 scribed in section 1861(s)(2)(J)),

12 ‘‘(iii) therapeutic shoes for diabetics

13 (as described in section 1861(s)(12)),

14 ‘‘(iv) oral drugs prescribed for use as

15 an anticancer therapeutic agent (as de16 scribed in section 1861(s)(2)(Q)), and

17 ‘‘(v) self-administered erythropoetin

18 (as described in section 1861(s)(2)(P)).’’.

19 (2) CONFORMING AMENDMENT.—Effective 60

20 days after the date of enactment of the Social Secu21 rity Act Amendments of 1994, paragraph (16) of

22 section 1834(a) (42 U.S.C. 1395m(a)) is repealed.

23 (b) USE OF COVERED ITEMS BY DISABLED BENE24 FICIARIES.—
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1 (1) IN GENERAL.—The Secretary of Health and

2 Human Services, in consultation with representa3 tives of suppliers of durable medical equipment

4 under part B of the medicare program and individ5 uals entitled to benefits under such program on the

6 basis of disability, shall conduct a study of the ef7 fects of the methodology for determining payments

8 for items of such equipment under such part on the

9 ability of such individuals to obtain items of such

10 equipment, including customized items.

11 (2) REPORT.—Not later than one year after the

12 date of the enactment of this Act, the Secretary

13 shall submit a report to Congress on the study con14 ducted under paragraph (1), and shall include in the

15 report such recommendations as the Secretary con16 siders appropriate to assure that disabled medicare

17 beneficiaries have access to items of durable medical

18 equipment.

19 (c) CRITERIA FOR TREATMENT OF ITEMS AS PROS20 THETIC DEVICES OR ORTHOTICS AND PROSTHETICS.—

21 Not later than one year after the date of the enactment

22 of this Act, the Secretary of Health and Human Services

23 shall submit a report to the Committees on Ways and

24 Means and Energy and Commerce of the House of Rep25 resentatives and the Committee on Finance of the Senate
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1 describing prosthetic devices or orthotics and prosthetics

2 covered under part B of the medicare program that do

3 not require individualized or custom fitting and adjust4 ment to be used by a patient. Such report shall include

5 recommendations for an appropriate methodology for de6 termining the amount of payment for such items under

7 such program.

8 SEC. 132. RESTRICTIONS ON CERTAIN MARKETING AND

9 SALES ACTIVITIES.

10 (a) PROHIBITING UNSOLICITED TELEPHONE CON11 TACTS FROM SUPPLIERS OF DURABLE MEDICAL EQUIP12 MENT TO MEDICARE BENEFICIARIES.—

13 (1) IN GENERAL.—Section 1834(a) (42 U.S.C.

14 1395m(a)) is amended by adding at the end the fol15 lowing new paragraph:

16 ‘‘(17) PROHIBITION AGAINST UNSOLICITED

17 TELEPHONE CONTACTS BY SUPPLIERS.—

18 ‘‘(A) IN GENERAL.—A supplier of a cov19 ered item under this subsection may not contact

20 an individual enrolled under this part by tele21 phone regarding the furnishing of a covered

22 item to the individual unless 1 of the following

23 applies:

24 ‘‘(i) The individual has given written

25 permission to the supplier to make contact
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1 by telephone regarding the furnishing of a

2 covered item.

3 ‘‘(ii) The supplier has furnished a cov4 ered item to the individual and the supplier

5 is contacting the individual only regarding

6 the furnishing of such covered item.

7 ‘‘(iii) If the contact is regarding the

8 furnishing of a covered item other than a

9 covered item already furnished to the indi10 vidual, the supplier has furnished at least

11 1 covered item to the individual during the

12 15-month period preceding the date on

13 which the supplier makes such contact.

14 ‘‘(B) PROHIBITING PAYMENT FOR ITEMS

15 FURNISHED SUBSEQUENT TO UNSOLICITED

16 CONTACTS.—If a supplier knowingly contacts

17 an individual in violation of subparagraph (A),

18 no payment may be made under this part for

19 any item subsequently furnished to the individ20 ual by the supplier.

21 ‘‘(C) EXCLUSION FROM PROGRAM FOR

22 SUPPLIERS ENGAGING IN PATTERN OF UNSO23 LICITED CONTACTS.—If a supplier knowingly

24 contacts individuals in violation of subpara25 graph (A) to such an extent that the supplier’s
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1 conduct establishes a pattern of contacts in vio2 lation of such subparagraph, the Secretary shall

3 exclude the supplier from participation in the

4 programs under this Act, in accordance with

5 the procedures set forth in subsections (c), (f),

6 and (g) of section 1128.’’.

7 (2) REQUIRING REFUND OF AMOUNTS COL8 LECTED FOR DISALLOWED ITEMS.—Section 1834(a)

9 (42 U.S.C. 1395m(a)), as amended by paragraph

10 (1), is amended by adding at the end the following

11 new paragraph:

12 ‘‘(18) REFUND OF AMOUNTS COLLECTED FOR

13 CERTAIN DISALLOWED ITEMS.—

14 ‘‘(A) IN GENERAL.—If a nonparticipating

15 supplier furnishes to an individual enrolled

16 under this part a covered item for which no

17 payment may be made under this part by rea18 son of paragraph (17)(B), the supplier shall re19 fund on a timely basis to the patient (and shall

20 be liable to the patient for) any amounts col21 lected from the patient for the item, unless—

22 ‘‘(i) the supplier establishes that the

23 supplier did not know and could not rea24 sonably have been expected to know that
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1 payment may not be made for the item by

2 reason of paragraph (17)(B), or

3 ‘‘(ii) before the item was furnished,

4 the patient was informed that payment

5 under this part may not be made for that

6 item and the patient has agreed to pay for

7 that item.

8 ‘‘(B) SANCTIONS.—If a supplier knowingly

9 and willfully fails to make refunds in violation

10 of subparagraph (A), the Secretary may apply

11 sanctions against the supplier in accordance

12 with section 1842(j)(2).

13 ‘‘(C) NOTICE.—Each carrier with a con14 tract in effect under this part with respect to

15 suppliers of covered items shall send any notice

16 of denial of payment for covered items by rea17 son of paragraph (17)(B) and for which pay18 ment is not requested on an assignment-related

19 basis to the supplier and the patient involved.

20 ‘‘(D) TIMELY BASIS DEFINED.—A refund

21 under subparagraph (A) is considered to be on

22 a timely basis only if—

23 ‘‘(i) in the case of a supplier who does

24 not request reconsideration or seek appeal

25 on a timely basis, the refund is made with-
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1 in 30 days after the date the supplier re2 ceives a denial notice under subparagraph

3 (C), or

4 ‘‘(ii) in the case in which such a re5 consideration or appeal is taken, the re6 fund is made within 15 days after the date

7 the supplier receives notice of an adverse

8 determination on reconsideration or ap9 peal.’’.

10 (b) CONFORMING AMENDMENT.—Section 1834(h)(3)

11 (42 U.S.C. 1395m(h)(3)) is amended by striking ‘‘Para12 graph (12)’’ and inserting ‘‘Paragraphs (12) and (17)’’.

13 (c) EFFECTIVE DATE.—The amendments made by

14 subsections (a) and (b) shall apply to items furnished after

15 the expiration of the 60-day period that begins on the date

16 of the enactment of this Act.

17 SEC. 133. BENEFICIARY LIABILITY FOR NONCOVERED

18 SERVICES.

19 (a) UNASSIGNED CLAIMS.—

20 (1) IN GENERAL.—Section 1834(j) (42 U.S.C.

21 1395m(i)), as added by section 131(a)(1), is amend22 ed—

23 (A) by redesignating paragraph (4) as

24 paragraph (5), and
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1 (B) by inserting after paragraph (3) the

2 following new paragraph:

3 ‘‘(4) LIMITATION ON PATIENT LIABILITY.—If a

4 supplier of medical equipment and supplies (as de5 fined in paragraph (5))—

6 ‘‘(A) furnishes an item or service to a ben7 eficiary for which no payment may be made by

8 reason of paragraph (1);

9 ‘‘(B) furnishes an item or service to a ben10 eficiary for which payment is denied in advance

11 under subsection (a)(15); or

12 ‘‘(C) furnishes an item or service to a ben13 eficiary for which payment is denied under sec14 tion 1862(a)(1);

15 any expenses incurred for items and services fur16 nished to an individual by such a supplier not on an

17 assigned basis shall be the responsibility of such

18 supplier. The individual shall have no financial re19 sponsibility for such expenses and the supplier shall

20 refund on a timely basis to the individual (and shall

21 be liable to the individual for) any amounts collected

22 from the individual for such items or services. The

23 provisions of subsection (a)(18) shall apply to re24 funds required under the previous sentence in the
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1 same manner as such provisions apply to refunds

2 under such subsection.’’.

3 (2) CONFORMING AMENDMENT.—Section

4 1128B(b)(3)(B) (42 U.S.C. 1320a–7b(b)(3)(B)), as

5 amended by section 134(a), is amended by striking

6 ‘‘1834(j)(4)’’ and inserting ‘‘1834(j)(5)’’.

7 (b) ASSIGNED CLAIMS.—Section 1879 (42 U.S.C.

8 1395pp) is amended by adding at the end the following

9 new subsection:

10 ‘‘(h) If a supplier of medical equipment and supplies

11 (as defined in section 1834(j)(5))—

12 ‘‘(1) furnishes an item or service to a bene13 ficiary for which no payment may be made by reason

14 of section 1834(j)(1);

15 ‘‘(2) furnishes an item or service to a bene16 ficiary for which payment is denied in advance under

17 section 1834(a)(15); or

18 ‘‘(3) furnishes an item or service to a bene19 ficiary for which no payment may be made by reason

20 of section 1834(a)(17)(B),

21 any expenses incurred for items and services furnished to

22 an individual by such a supplier on an assignment-related

23 basis shall be the responsibility of such supplier. The indi24 vidual shall have no financial responsibility for such ex25 penses and the supplier shall refund on a timely basis to
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1 the individual (and shall be liable to the individual for)

2 any amounts collected from the individual for such items

3 or services. The provisions of section 1834(a)(18) shall

4 apply to refunds required under the previous sentence in

5 the same manner as such provisions apply to refunds

6 under such section.’’.

7 (c) EFFECTIVE DATE.—The amendments made by

8 this section shall apply to items or services furnished on

9 or after January 1, 1995.

10 SEC. 134. ADJUSTMENTS FOR INHERENT REASONABLE11 NESS.

12 (a) ADJUSTMENTS MADE TO FINAL PAYMENT

13 AMOUNTS.—

14 (1) IN GENERAL.—Section 1834(a)(10)(B) (42

15 U.S.C. 1395m(a)(10)(B)) is amended by adding at

16 the end the following: ‘‘In applying such provisions

17 to payments for an item under this subsection, the

18 Secretary shall make adjustments to the payment

19 basis for the item described in paragraph (1)(B) if

20 the Secretary determines (in accordance with such

21 provisions and on the basis of prices and costs appli22 cable at the time the item is furnished) that such

23 payment basis is not inherently reasonable.’’.
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1 (2) EFFECTIVE DATE.—The amendment made

2 by paragraph (1) shall take effect on the date of the

3 enactment of this Act.

4 (b) ADJUSTMENT REQUIRED FOR CERTAIN ITEMS.—

5 (1) IN GENERAL.—In accordance with section

6 1834(a)(10)(B) of the Social Security Act (as

7 amended by subsection (a)), the Secretary of Health

8 and Human Services shall determine whether the

9 payment amounts for the items described in para10 graph (2) are not inherently reasonable, and shall

11 adjust such amounts in accordance with such section

12 if the amounts are not inherently reasonable.

13 (2) ITEMS DESCRIBED.—The items referred to

14 in paragraph (1) are decubitus care equipment,

15 transcutaneous electrical nerve stimulators, and any

16 other items considered appropriate by the Secretary.

17 SEC. 135. MISCELLANEOUS AND TECHNICAL CORRECTIONS.

18 (a) UPDATES TO PAYMENT AMOUNTS.—(1) Subpara19 graph (A) of section 1834(a)(14) (42 U.S.C.

20 1395m(a)(14)) is amended to read as follows:

21 ‘‘(A) for 1991 and 1992, the percentage

22 increase in the consumer price index for all

23 urban consumers (U.S. city average) for the 12-

24 month period ending with June of the previous

25 year reduced by 1 percentage point; and’’.
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1 (2) The amendment made by paragraph (1) shall be

2 effective on the date of the enactment of this Act.

3 (b) ADVANCE DETERMINATIONS OF COVERAGE.—(1)

4 Effective on the date of the enactment of this Act, section

5 1834(a)(15) (42 U.S.C. 1395m(a)(15)) is amended to

6 read as follows:

7 ‘‘(15) ADVANCE DETERMINATIONS OF COV8 ERAGE FOR CERTAIN ITEMS.—

9 ‘‘(A) DEVELOPMENT OF LISTS OF ITEMS

10 BY SECRETARY.—The Secretary may develop

11 and periodically update a list of items for which

12 payment may be made under this subsection

13 that the Secretary determines, on the basis of

14 prior payment experience, are frequently subject

15 to unnecessary utilization throughout a carrier’s

16 entire service area or a portion of such area.

17 ‘‘(B) DEVELOPMENT OF LISTS OF SUPPLI18 ERS BY SECRETARY.—The Secretary may de19 velop and periodically update a list of suppliers

20 of items for which payment may be made under

21 this subsection with respect to whom—

22 ‘‘(i) the Secretary has found that a

23 substantial number of claims for payment

24 under this part for items furnished by the
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1 supplier have been denied on the basis of

2 the application of section 1862(a)(1); or

3 ‘‘(ii) the Secretary has identified a

4 pattern of overutilization resulting from

5 the business practice of the supplier.

6 ‘‘(C) DETERMINATIONS OF COVERAGE IN

7 ADVANCE.—A carrier shall determine in ad8 vance of delivery of an item whether payment

9 for the item may not be made because the item

10 is not covered or because of the application of

11 section 1862(a)(1) if—

12 ‘‘(i) the item is included on the list

13 developed by the Secretary under subpara14 graph (A);

15 ‘‘(ii) the item is furnished by a sup16 plier included on the list developed by the

17 Secretary under subparagraph (B); or

18 ‘‘(iii) the item is a customized item

19 (other than inexpensive items specified by

20 the Secretary) and the patient to whom the

21 item is to be furnished or the supplier re22 quests that such advance determination be

23 made.’’.

24 (2) Effective for standards applied for contract years

25 beginning after the date of the enactment of this Act, sec-
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1 tion 1842(c) (42 U.S.C. 1395u(c)), as amended by section

2 125(a), is amended by adding at the end the following new

3 paragraph:

4 ‘‘(5) Each contract under this section which provides

5 for the disbursement of funds, as described in subsection

6 (a)(1)(B), shall require the carrier to meet criteria devel7 oped by the Secretary to measure the timeliness of carrier

8 responses to requests for payment of items described in

9 section 1834(a)(15)(C).’’.

10 (3) Effective on the date of the enactment of this Act,

11 section 1834(h)(3) (42 U.S.C. 1395m(h)(3)), as amended

12 by section 133(b), is amended by striking ‘‘(12) and (17)’’

13 and inserting ‘‘(12), (15), and (17)’’.

14 (c) STUDY OF VARIATIONS IN DURABLE MEDICAL

15 EQUIPMENT SUPPLIER COSTS.—

16 (1) COLLECTION AND ANALYSIS OF SUPPLIER

17 COST DATA.—The Administrator of the Health Care

18 Financing Administration shall, in consultation with

19 appropriate organizations, collect data on supplier

20 costs of durable medical equipment for which pay21 ment may be made under part B of the medicare

22 program, and shall analyze such data to determine

23 the proportions of such costs attributable to the

24 service and product components of furnishing such

25 equipment and the extent to which such proportions
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1 vary by type of equipment and by the geographic re2 gion in which the supplier is located.

3 (2) DEVELOPMENT OF GEOGRAPHIC ADJUST4 MENT INDEX; REPORTS.—Not later than July 1,

5 1995—

6 (A) the Administrator shall submit a re7 port to the Committees on Energy and Com8 merce and Ways and Means of the House of

9 Representatives and the Committee on Finance

10 of the Senate on the data collected and the

11 analysis conducted under paragraph (1), and

12 shall include in such report the Administrator’s

13 recommendations for a geographic cost adjust14 ment index for suppliers of durable medical

15 equipment under the medicare program and an

16 analysis of the impact of such proposed index

17 on payments under the medicare program; and

18 (B) the Comptroller General shall submit a

19 report to the Committees on Energy and Com20 merce and Ways and Means of the House of

21 Representatives and the Committee on Finance

22 of the Senate analyzing on a geographic basis

23 the supplier costs of durable medical equipment

24 under the medicare program.
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1 (d) OXYGEN RETESTING.—(1) Section

2 1834(a)(5)(E) (42 U.S.C. 1395m(a)(5)(E)) is amended by

3 striking ‘‘55’’ and inserting ‘‘56’’.

4 (2) The amendment made by paragraph (1) shall be

5 effective on the date of the enactment of this Act.

6 (e) OTHER MISCELLANEOUS AND TECHNICAL

7 AMENDMENTS.—(1) Section 4152(a)(3) of OBRA–1990

8 is amended by striking ‘‘amendment made by subsection

9 (a)’’ and inserting ‘‘amendments made by this sub10 section’’.

11 (2) Section 4152(c)(2) of OBRA–1990 is amended

12 by striking ‘‘1395m(a)(7)(A)’’ and inserting

13 ‘‘1395m(a)(7)’’.

14 (3) Section 1834(a)(7)(A)(iii)(II) (42 U.S.C.

15 1395m(a)(7)(A)(iii)(II)) is amended by striking ‘‘clause

16 (v)’’ and inserting ‘‘clause (vi)’’.

17 (4) Section 1834(a)(7)(C)(i) (42 U.S.C.

18 1395m(a)(7)(C)(i)) is amended by striking ‘‘or paragraph

19 (3)’’.

20 (5) Section 1834(a)(3) (42 U.S.C. 1395m(a)(3)) is

21 amended by striking subparagraph (D).

22 (6) Section 4153(c)(1) of OBRA–1990 is amended

23 by striking ‘‘1834(a)’’ and inserting ‘‘1834(h)’’.
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1 (7) Section 4153(d)(2) of OBRA–1990 is amended

2 by striking ‘‘Reconiliation’’ and inserting ‘‘Reconcili3 ation’’.

4 (8) The amendments made by this subsection shall

5 take effect as if included in the enactment of OBRA–1990.

6 PART III—OTHER ITEMS AND SERVICES

7 SEC. 141. AMBULATORY SURGICAL CENTER SERVICES.

8 (a) PAYMENT AMOUNTS FOR SERVICES FURNISHED

9 IN AMBULATORY SURGICAL CENTERS.—

10 (1) USE OF SURVEY TO DETERMINE INCURRED

11 COSTS.—Section 1833(i)(2)(A)(i) (42 U.S.C.

12 1395l(i)(2)(A)(i)) is amended by striking the comma

13 at the end and inserting the following: ‘‘, as deter14 mined in accordance with a survey (based upon a

15 representative sample of procedures and facilities)

16 taken not later than January 1, 1995, and every 5

17 years thereafter, of the actual audited costs incurred

18 by such centers in providing such services,’’.

19 (2) AUTOMATIC APPLICATION OF INFLATION

20 ADJUSTMENT.—Section 1833(i)(2) (42 U.S.C.

21 1395l(i)(2)) is amended—

22 (A) in the second sentence of subpara23 graph (A) and the second sentence of subpara24 graph (B), by striking ‘‘and may be adjusted by

25 the Secretary, when appropriate,’’; and
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1 (B) by adding at the end the following new

2 subparagraph:

3 ‘‘(C) Notwithstanding the second sentence of sub4 paragraph (A) or the second sentence of subparagraph

5 (B), if the Secretary has not updated amounts established

6 under such subparagraphs with respect to facility services

7 furnished during a fiscal year (beginning with fiscal year

8 1996), such amounts shall be increased by the percentage

9 increase in the consumer price index for all urban consum10 ers (U.S. city average) as estimated by the Secretary for

11 the 12-month period ending with the midpoint of the year

12 involved.’’.

13 (3) CONSULTATION REQUIREMENT.—The sec14 ond sentence of section 1833(i)(1) (42 U.S.C.

15 1395l(i)(1)) is amended by striking the period and

16 inserting the following: ‘‘, in consultation with ap17 propriate trade and professional organizations.’’.

18 (b) ADJUSTMENTS TO PAYMENT AMOUNTS FOR NEW

19 TECHNOLOGY INTRAOCULAR LENSES.—

20 (1) ESTABLISHMENT OF PROCESS FOR REVIEW

21 OF AMOUNTS.—Not later than 1 year after the date

22 of the enactment of this Act, the Secretary of

23 Health and Human Services (in this subsection re24 ferred to as the ‘‘Secretary’’) shall develop and im25 plement a process under which interested parties
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1 may request review by the Secretary of the appro2 priateness of the reimbursement amount provided

3 under section 1833(i)(2)(A)(iii) of the Social Secu4 rity Act with respect to a class of new technology

5 intraocular lenses. For purposes of the preceding

6 sentence, an intraocular lens may not be treated as

7 a new technology lens unless it has been approved

8 by the Food and Drug Administration.

9 (2) FACTORS CONSIDERED.—In determining

10 whether to provide an adjustment of payment with

11 respect to a particular lens under paragraph (1), the

12 Secretary shall take into account whether use of the

13 lens is likely to result in reduced risk of

14 intraoperative or postoperative complication or trau15 ma, accelerated postoperative recovery, reduced in16 duced astigmatism, improved postoperative visual

17 acuity, more stable postoperative vision, or other

18 comparable clinical advantages.

19 (3) NOTICE AND COMMENT.—The Secretary

20 shall publish notice in the Federal Register from

21 time to time (but no less often than once each year)

22 of a list of the requests that the Secretary has re23 ceived for review under this subsection, and shall

24 provide for a 30-day comment period on the lenses

25 that are the subjects of the requests contained in
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1 such notice. The Secretary shall publish a notice of

2 the Secretary’s determinations with respect to intra3 ocular lenses listed in the notice within 90 days after

4 the close of the comment period.

5 (4) EFFECTIVE DATE OF ADJUSTMENT.—Any

6 adjustment of a payment amount (or payment limit)

7 made under this subsection shall become effective

8 not later than 30 days after the date on which the

9 notice with respect to the adjustment is published

10 under paragraph (3).

11 (c) TECHNICAL CORRECTION RELATING TO BLEND

12 AMOUNTS FOR AMBULATORY SURGICAL CENTER PAY13 MENTS.—

14 (1) IN GENERAL.—Subclauses (I) and (II) of

15 section 1833(i)(3)(B)(ii) (42 U.S.C.

16 1395l(i)(3)(B)(ii)) are each amended—

17 (A) by striking ‘‘for reporting’’ and insert18 ing ‘‘for portions of cost reporting’’; and

19 (B) by striking ‘‘and on or before’’ and in20 serting ‘‘and ending on or before’’.

21 (2) EFFECTIVE DATE.—The amendments made

22 by paragraph (1) shall take effect as if included in

23 the enactment of OBRA–1990.

24 (d) TECHNICAL CORRECTION RELATED TO CATA25 RACT SURGERY.—Effective as if included in the enact-
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1 ment of OBRA–1990, section 4151(c)(3) of such Act is

2 amended by striking ‘‘for the insertion of an intraocular

3 lens’’ and inserting ‘‘for an intraocular lens inserted’’.

4 SEC. 142. STUDY OF MEDICARE COVERAGE OF PATIENT

5 CARE COSTS ASSOCIATED WITH CLINICAL

6 TRIALS OF NEW CANCER THERAPIES.

7 (a) STUDY.—The Secretary of Health and Human

8 Services shall conduct a study of the effects of expressly

9 covering under the medicare program the patient care

10 costs for beneficiaries enrolled in clinical trials of new can11 cer therapies, where the protocol for the trial has been

12 approved by the National Cancer Institute or meets simi13 lar scientific and ethical standards, including approval by

14 an institutional review board. The study shall include—

15 (1) an estimate of the cost of such coverage,

16 taking into account the extent to which medicare

17 currently pays for such patient care costs in prac18 tice;

19 (2) an assessment of the extent to which such

20 clinical trials represent the best available treatment

21 for the patients involved and of the effects of partici22 pation in the trials on the health of such patients;

23 (3) an assessment of whether progress in devel24 oping new anticancer therapies would be assisted by

25 medicare coverage of such patient care costs; and
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1 (4) an evaluation of whether there should be

2 special criteria for the admission of medicare bene3 ficiaries (on account of their age or physical condi4 tion) to clinical trials for which medicare would pay

5 the patient care costs.

6 (b) REPORT.—Not later than 2 years after the date

7 of the enactment of this Act, the Secretary of Health and

8 Human Services shall submit a report on the study con9 ducted under subsection (a) to the Committee on Ways

10 and Means and the Committee on Energy and Commerce

11 of the House of Representatives and the Committee on

12 Finance of the Senate. Such report shall include rec13 ommendations as to the coverage under the medicare pro14 gram of patient care costs of beneficiaries enrolled in clini15 cal trials of new cancer therapies.

16 SEC. 143. STUDY OF ANNUAL CAP ON AMOUNT OF MEDI17 CARE PAYMENT FOR OUTPATIENT PHYSICAL

18 THERAPY AND OCCUPATIONAL THERAPY

19 SERVICES.

20 (a) STUDY.—The Secretary of Health and Human

21 Services shall conduct a study of the appropriateness of

22 continuing an annual limitation on the amount of payment

23 for outpatient services of independently practicing physical

24 and occupational therapists under the medicare program.
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1 (b) REPORT.—By not later than January 1, 1996,

2 the Secretary shall submit to the Committees on Energy

3 and Commerce and Ways and Means of the House of Rep4 resentatives and the Committee on Finance of the Senate

5 a report on the study conducted under subsection (a).

6 Such report shall include such recommendations for

7 changes in such annual limitation as the Secretary finds

8 appropriate.

9 SEC. 144. PAYMENT OF PART B PREMIUM LATE ENROLL10 MENT PENALTIES BY STATES.

11 Section 1839 (42 U.S.C. 1395r) is amended by add12 ing at the end the following new subsection:

13 ‘‘(g)(1) Upon the request of a State, the Secretary

14 may enter into an agreement with the State under which

15 the State agrees to pay on a quarterly or other periodic

16 basis to the Secretary (to be deposited in the Treasury

17 to the credit of the Federal Supplementary Medical Insur18 ance Trust Fund) an amount equal to the amount of the

19 part B late enrollment premium increases with respect to

20 the premiums for eligible individuals (as defined in para21 graph (3)(A)).

22 ‘‘(2) No part B late enrollment premium increase

23 shall apply to an eligible individual for premiums for

24 months for which the amount of such an increase is pay25 able under an agreement under paragraph (1).
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1 ‘‘(3) In this subsection:

2 ‘‘(A) The term ‘eligible individual’ means an in3 dividual who is enrolled under this part B and who

4 is within a class of individuals specified in the agree5 ment under paragraph (1).

6 ‘‘(B) The term ‘part B late enrollment premium

7 increase’ means any increase in a premium as a re8 sult of the application of subsection (b).’’.

9 SEC. 145. APPLICATION OF MAMMOGRAPHY CERTIFI10 CATION REQUIREMENTS.

11 (a) SCREENING MAMMOGRAPHY.—Section 1834(c)

12 (42 U.S.C. 1395m(c)) is amended—

13 (1) in paragraph (1)(B), by striking ‘‘meets the

14 quality standards established under paragraph (3)’’

15 and inserting ‘‘is conducted by a facility that has a

16 certificate (or provisional certificate) issued under

17 section 354 of the Public Health Service Act’’;

18 (2) in paragraph (1)(C)(iii), by striking ‘‘para19 graph (4)’’ and inserting ‘‘paragraph (3)’’;

20 (3) by striking paragraph (3); and

21 (4) by redesignating paragraphs (4) and (5) as

22 paragraphs (3) and (4).

23 (b) DIAGNOSTIC MAMMOGRAPHY.—Section

24 1861(s)(3) (42 U.S.C. 1395x(s)(3)) is amended by insert25 ing ‘‘and including diagnostic mammography if conducted
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1 by a facility that has a certificate (or provisional certifi2 cate) issued under section 354 of the Public Health Serv3 ice Act’’ after ‘‘necessary’’.

4 (c) CONFORMING AMENDMENTS.—(1) Section

5 1862(a)(1)(F) (42 U.S.C. 1395y(a)(1)(F)) is amended by

6 striking ‘‘or which does not meet the standards established

7 under section 1834(c)(3)’’ and inserting ‘‘or which is not

8 conducted by a facility described in section

9 1834(c)(1)(B)’’.

10 (2) Section 1863 (42 U.S.C. 1395z) is amended by

11 striking ‘‘or whether screening mammography meets the

12 standards established under section 1834(c)(3),’’.

13 (3) The first sentence of section 1864(a) (42 U.S.C.

14 1395aa(a)) is amended by striking ‘‘, or whether screening

15 mammography meets the standards established under sec16 tion 1834(c)(3)’’.

17 (4) The third sentence of section 1865(a) (42 U.S.C.

18 1395bb(a)) is amended by striking ‘‘1834(c)(3),’’.

19 (d) EFFECTIVE DATE.—The amendments made by

20 this section shall apply to mammography furnished by a

21 facility on and after the first date that the certificate re22 quirements of section 354(b) of the Public Health Service

23 Act apply to such mammography conducted by such facil24 ity.
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1 SEC. 146. COVERAGE OF SERVICES OF SPEECH-LANGUAGE

2 PATHOLOGISTS AND AUDIOLOGISTS.

3 (a) SERVICES DEFINED.—Section 1861 (42 U.S.C.

4 1395x), as amended by section 148(f)(6)(E), is amended

5 by inserting after subsection (kk) the following new sub6 section:

7 ‘‘Speech-Language Pathology Services; Audiology

8 Services

9 ‘‘(ll)(1) The term ‘speech-language pathology serv10 ices’ means such speech, language, and related function

11 assessment and rehabilitation services furnished by a

12 qualified speech-language pathologist as the speech-lan13 guage pathologist is legally authorized to perform under

14 State law (or the State regulatory mechanism provided by

15 State law) as would otherwise be covered if furnished by

16 a physician.

17 ‘‘(2) The term ‘audiology services’ means such hear18 ing and balance assessment services furnished by a quali19 fied audiologist as the audiologist is legally authorized to

20 perform under State law (or the State regulatory mecha21 nism provided by State law), as would otherwise be cov22 ered if furnished by a physician.

23 ‘‘(3) In this subsection:

24 ‘‘(A) The term ‘qualified speech-language pa25 thologist’ means an individual with a master’s or

26 doctoral degree in speech-language pathology who—
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1 ‘‘(i) is licensed as a speech-language pa2 thologist by the State in which the individual

3 furnishes such services, or

4 ‘‘(ii) in the case of an individual who fur5 nishes services in a State which does not license

6 speech-language pathologists, has successfully

7 completed 350 clock hours of supervised clinical

8 practicum (or is in the process of accumulating

9 such supervised clinical experience), performed

10 not less than 9 months of supervised full-time

11 speech-language pathology services after obtain12 ing a master’s or doctoral degree in speech-lan13 guage pathology or a related field, and success14 fully completed a national examination in

15 speech-language pathology approved by the Sec16 retary.

17 ‘‘(B) The term ‘qualified audiologist’ means an

18 individual with a master’s or doctoral degree in

19 audiology who—

20 ‘‘(i) is licensed as an audiologist by the

21 State in which the individual furnishes such

22 services, or

23 ‘‘(ii) in the case of an individual who fur24 nishes services in a State which does not license

25 audiologists has successfully completed 350
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1 clock hours of supervised clinical practicum (or

2 is in the process of accumulating such super3 vised clinical experience), performed not less

4 than 9 months of supervised full-time audiology

5 services after obtaining a master’s or doctoral

6 degree in audiology or a related field, and suc7 cessfully completed a national examination in

8 audiology approved by the Secretary.’’.

9 (b) CONFORMING AMENDMENTS RELATING TO MED10 ICARE TREATMENT OF SPEECH AND LANGUAGE SERV11 ICES.—

12 (1) EXTENDED CARE SERVICES.—Section

13 1861(h)(3) (42 U.S.C. 1395x(h)(3)) is amended by

14 striking ‘‘, occupational, or speech therapy’’ and in15 serting ‘‘or occupational therapy or speech-language

16 pathology services’’.

17 (2) HOME HEALTH SERVICES.—Section

18 1861(m)(2) (42 U.S.C. 1395x(m)(2)) is amended by

19 striking ‘‘, occupational, or speech therapy’’ and in20 serting ‘‘or occupational therapy or speech-language

21 pathology services’’.

22 (3) OUTPATIENT PHYSICAL THERAPY SERV23 ICES.—The fourth sentence of section 1861(p) (42

24 U.S.C. 1395x(p)) is amended by striking ‘‘speech
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1 pathology services’’ and inserting ‘‘speech-language

2 pathology services’’.

3 (4) COMPREHENSIVE OUTPATIENT REHABILITA4 TION FACILITY SERVICES.—Section 1861(cc)(1)(B)

5 (42 U.S.C. 1395x(cc)(1)(B)) is amended by striking

6 ‘‘speech pathology services’’ and inserting ‘‘speech7 language pathology services’’.

8 (5) HOSPICE CARE.—Section 1861(dd)(1)(B)

9 (42 U.S.C. 1395x(dd)(1)(B)) is amended by striking

10 ‘‘therapy or speech-language pathology’’ and insert11 ing ‘‘therapy, or speech-language pathology serv12 ices’’.

13 (c) EFFECTIVE DATE.—The amendments made by

14 this section shall take effect on January 1, 1995.

15 SEC. 147. MISCELLANEOUS AND TECHNICAL CORRECTIONS.

16 (a) REVISION OF INFORMATION ON PART B CLAIMS

17 FORMS.—Section 1833(q)(1) (42 U.S.C. 1395l(q)(1)) is

18 amended—

19 (1) by striking ‘‘provider number’’ and inserting

20 ‘‘unique physician identification number’’; and

21 (2) by striking ‘‘and indicate whether or not the

22 referring physician is an interested investor (within

23 the meaning of section 1877(h)(5))’’.
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1 (b) CONSULTATION FOR SOCIAL WORKERS.—Effec2 tive with respect to services furnished on or after January

3 1, 1991, section 6113(c) of OBRA–1989 is amended—

4 (1) by inserting ‘‘and clinical social worker

5 services’’ after ‘‘psychologist services’’; and

6 (2) by striking ‘‘psychologist’’ the second and

7 third place it appears and inserting ‘‘psychologist or

8 clinical social worker’’.

9 (c) REPORTS ON HOSPITAL OUTPATIENT PAY10 MENT.—(1) OBRA–1989 is amended by striking section

11 6137.

12 (2) Section 1135(d) (42 U.S.C. 1320b–5(d)) is

13 amended—

14 (A) by striking paragraph (6); and

15 (B) in paragraph (7)—

16 (i) by striking ‘‘systems’’ each place it ap17 pears and inserting ‘‘system’’; and

18 (ii) by striking ‘‘paragraphs (1) and (6)’’

19 and inserting ‘‘paragraph (1)’’.

20 (d) RADIOLOGY AND DIAGNOSTIC SERVICES PRO21 VIDED IN HOSPITAL OUTPATIENT DEPARTMENTS.—(1)

22 Effective as if included in the enactment of OBRA–1989,

23 section 1833(n)(1)(B)(i)(II) (42 U.S.C.

24 1395l(n)(1)(B)(i)(II)) is amended—
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1 (A) by inserting ‘‘and for services described in

2 subsection (a)(2)(E)(ii) furnished on or after Janu3 ary 1, 1992’’ after ‘‘1989’’; and

4 (B) by striking ‘‘1842(b)’’ and inserting

5 ‘‘1842(b) (or, in the case of services furnished on or

6 after January 1, 1992, under section 1848)’’.

7 (2) Effective as if included in the enactment of

8 OBRA–1989, section 1833(n)(1)(B)(i)(II) (42 U.S.C.

9 1395l(n)(1)(B)(i)(II)) is amended by striking ‘‘January 1,

10 1989’’ and inserting ‘‘April 1, 1989’’.

11 (e) PAYMENTS TO NURSE PRACTITIONERS IN RURAL

12 AREAS (SECTION 4155 OF OBRA–1990).—(1) Section

13 1861(s)(2)(K)(iii) (42 U.S.C. 1395x(s)(2)(K)(iii)) is

14 amended—

15 (A) by striking ‘‘subsection (aa)(3)’’ and insert16 ing ‘‘subsection (aa)(5)’’; and

17 (B) by striking ‘‘subsection (aa)(4)’’ and insert18 ing ‘‘subsection (aa)(6)’’.

19 (2) Section 1833(r)(1) (42 U.S.C. 1395l(r)(1)) is

20 amended—

21 (A) by striking ‘‘ambulatory’’ each place it ap22 pears and inserting ‘‘or ambulatory’’; and

23 (B) by striking ‘‘center,’’ and inserting ‘‘cen24 ter’’.
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1 (3) Section 1833(r)(2)(A) (42 U.S.C. 1395l(r)(2)(A))

2 is amended by striking ‘‘subsection (a)(1)(M)’’ and insert3 ing ‘‘subsection (a)(1)(O)’’.

4 (4) Section 1861(b)(4) (42 U.S.C. 1395x(b)(4)) is

5 amended by striking ‘‘subsection (s)(2)(K)(i)’’ and insert6 ing ‘‘clauses (i) or (iii) of subsection (s)(2)(K)’’.

7 (5) Section 1861(aa)(5) (42 U.S.C. 1395x(aa)(5)) is

8 amended by striking ‘‘this Act’’ and inserting ‘‘this title’’.

9 (6) Section 1862(a)(14) (42 U.S.C. 1395y(a)(14)) is

10 amended by striking ‘‘1861(s)(2)(K)(i)’’ and inserting

11 ‘‘1861(s)(2)(K)(i) or 1861(s)(2)(K)(iii)’’.

12 (7) Section 1866(a)(1)(H) (42 U.S.C.

13 1395cc(a)(1)(H)) is amended by striking

14 ‘‘1861(s)(2)(K)(i)’’ and inserting ‘‘1861(s)(2)(K)(i) or

15 1861(s)(2)(K)(iii)’’.

16 (f) OTHER MISCELLANEOUS AND TECHNICAL

17 AMENDMENTS.—

18 (1) IMMEDIATE ENROLLMENT IN PART B BY IN19 DIVIDUALS COVERED BY AN EMPLOYMENT-BASED

20 PLAN.—(A) Subparagraphs (A) and (B) of section

21 1837(i)(3) (42 U.S.C. 1395p(i)(3)) are each amend22 ed—

23 (i) by striking ‘‘beginning with the first

24 day of the first month in which the individual

25 is no longer enrolled’’ and inserting ‘‘including
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1 each month during any part of which the indi2 vidual is enrolled’’; and

3 (ii) by striking ‘‘and ending seven months

4 later’’ and inserting ‘‘ending with the last day

5 of the eighth consecutive month in which the in6 dividual is at no time so enrolled’’.

7 (B) Paragraphs (1) and (2) of section 1838(e)

8 (42 U.S.C. 1395q(e)) are amended to read as fol9 lows:

10 ‘‘(1) in any month of the special enrollment pe11 riod in which the individual is at any time enrolled

12 in a plan (specified in subparagraph (A) or (B), as

13 applicable, of section 1837(i)(3)) or in the first

14 month following such a month, the coverage period

15 shall begin on the first day of the month in which

16 the individual so enrolls (or, at the option of the in17 dividual, on the first day of any of the following

18 three months), or

19 ‘‘(2) in any other month of the special enroll20 ment period, the coverage period shall begin on the

21 first day of the month following the month in which

22 the individual so enrolls.’’.

23 (C) The amendments made by subparagraphs

24 (A) and (B) shall take effect on the first day of the

25 first month that begins after the expiration of the
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1 120-day period that begins on the date of the enact2 ment of this Act.

3 (2) CLINICAL DIAGNOSTIC LABORATORY

4 TESTS.—Section 4154(e)(5) of OBRA–1990 is

5 amended by striking ‘‘(1)(A)’’ and inserting

6 ‘‘(1)(A),’’.

7 (3) SEPARATE PAYMENT UNDER PART B FOR

8 CERTAIN SERVICES.—Section 4157(a) of OBRA–

9 1990 is amended by striking ‘‘(a) SERVICES OF’’

10 and all that follows through ‘‘Section’’ and inserting

11 ‘‘(a) TREATMENT OF SERVICES OF CERTAIN

12 HEALTH PRACTITIONERS.—Section’’.

13 (4) COMMUNITY HEALTH CENTERS AND RURAL

14 HEALTH CLINICS.—(A) The fourth sentence of sec15 tion 1861(aa)(2) (42 U.S.C. 1395x(aa)(2)) is

16 amended—

17 (i) by striking ‘‘certification’’ the first

18 place it appears and inserting ‘‘approval’’; and

19 (ii) by striking ‘‘the Secretary’s approval

20 or disapproval of the certification’’ and insert21 ing ‘‘Secretary’s approval or disapproval’’.

22 (B) Section 4161(a)(7)(B) of OBRA–1990 is

23 amended by inserting ‘‘and to the Committee on Fi24 nance of the Senate’’ after ‘‘Representatives’’.
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1 (5) SCREENING MAMMOGRAPHY.—Section 4163

2 of OBRA–1990 is amended—

3 (A) by adding at the end of subsection (d)

4 the following new paragraph:

5 ‘‘(3) The amendment made by paragraph

6 (2)(A)(iv) shall apply to screening pap smears per7 formed on or after July 1, 1990.’’; and

8 (B) in subsection (e), by striking ‘‘The

9 amendments’’ and inserting ‘‘Except as pro10 vided in subsection (d)(3), the amendments’’.

11 (6) INJECTABLE DRUGS FOR TREATMENT OF

12 OSTEOPOROSIS.—

13 (A) CLARIFICATION OF DRUGS COV14 ERED.—The section 1861(jj) (42 U.S.C.

15 1395x(jj)) inserted by section 4156(a)(2) of

16 OBRA–1990 is amended—

17 (i) in the matter preceding paragraph

18 (1), by striking ‘‘a bone fracture related

19 to’’; and

20 (ii) in paragraph (1), by striking ‘‘pa21 tient’’ and inserting ‘‘individual has suf22 fered a bone fracture related to post-meno23 pausal osteoporosis and that the individ24 ual’’.
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1 (B) LIMITING COVERAGE TO DRUGS PRO2 VIDED BY HOME HEALTH AGENCIES.—(i) The

3 section 1861(jj) (42 U.S.C. 1395x(jj)) inserted

4 by section 4156(a)(2) of OBRA–1990 is

5 amended by striking ‘‘if’’ and inserting ‘‘by a

6 home health agency if’’.

7 (ii) Section 1861(m)(5) (42 U.S.C.

8 1395x(m)(5)) is amended by striking ‘‘but ex9 cluding’’ and inserting ‘‘and a covered

10 osteoporosis drug (as defined in subsection

11 (kk), but excluding other’’.

12 (iii) Section 1861(s)(2) (42 U.S.C.

13 1395x(s)(2)) is amended—

14 (I) by adding ‘‘and’’ at the end of

15 subparagraph (N), and

16 (II) by striking subparagraph (O) and

17 redesignating subparagraph (P) as sub18 paragraph (O).

19 (C) PAYMENT BASED ON REASONABLE

20 COST.—Section 1833(a)(2) (42 U.S.C.

21 1395l(a)(2)) is amended—

22 (i) in subparagraph (A), by striking

23 ‘‘health services’’ and inserting ‘‘health

24 services (other than a covered osteoporosis

25 drug (as defined in section 1861(kk)))’’;
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1 (ii) by striking ‘‘and’’ at the end of

2 subparagraph (D);

3 (iii) by striking the semicolon at the

4 end of subparagraph (E) and inserting ‘‘;

5 and’’; and

6 (iv) by adding at the end the following

7 new subparagraph:

8 ‘‘(F) with respect to a covered osteoporosis

9 drug (as defined in section 1861(kk)) furnished

10 by a home health agency, 80 percent of the rea11 sonable cost of such service, as determined

12 under section 1861(v);’’.

13 (D) APPLICATION OF PART B DEDUCT14 IBLE.—Section 1833(b)(2) (42 U.S.C.

15 1395l(b)(2)) is amended by striking ‘‘services’’

16 and inserting ‘‘services (other than a covered

17 osteoporosis drug (as defined in section

18 1861(kk)))’’.

19 (E) COVERED OSTEOPOROSIS DRUG (SEC20 TION 4156 OF OBRA–1990).—Section 1861 (42

21 U.S.C. 1395x) is amended, in the subsection

22 (jj) inserted by section 4156(a)(2) of OBRA–

23 1990, by striking ‘‘(jj) The term’’ and inserting

24 ‘‘(kk) The term’’.
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1 (7) OTHER MISCELLANEOUS AND TECHNICAL

2 CORRECTIONS.—

3 (A) OWNERSHIP DISCLOSURE REQUIRE4 MENTS.—(i) Section 1124A(a)(2)(A) (42

5 U.S.C. 1320a–3a(a)(2)(A)) is amended by

6 striking ‘‘of the Social Security Act’’.

7 (ii) Section 4164(b)(4) of OBRA–1990 is

8 amended by striking ‘‘paragraph’’ and inserting

9 ‘‘paragraphs’’.

10 (B) DIRECTORY OF UNIQUE PHYSICIAN

11 IDENTIFIER NUMBERS.—Section 4164(c) of

12 OBRA–1990 is amended by striking ‘‘publish’’

13 and inserting ‘‘publish, and shall periodically

14 update,’’.

15 (g) EFFECTIVE DATE.—Except as otherwise provided

16 in this section, the amendments made by this section shall

17 take effect as if included in the enactment of OBRA–1990.

18 Subtitle C—Provisions Relating to

19 Parts A and B

20 SEC. 151. MEDICARE SECONDARY PAYER REFORMS.

21 (a) IMPROVING IDENTIFICATION OF MEDICARE SEC22 ONDARY PAYER SITUATIONS.—

23 (1) SURVEY OF BENEFICIARIES.—
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1 (A) IN GENERAL.—Section 1862(b)(5) (42

2 U.S.C. 1395y(b)(5)) is amended by adding at

3 the end the following new subparagraph:

4 ‘‘(D) OBTAINING INFORMATION FROM

5 BENEFICIARIES.—Before an individual applies

6 for benefits under part A or enrolls under part

7 B, the Administrator shall mail the individual a

8 questionnaire to obtain information on whether

9 the individual is covered under a primary plan

10 and the nature of the coverage provided under

11 the plan, including the name, address, and iden12 tifying number of the plan.’’.

13 (B) DISTRIBUTION OF QUESTIONNAIRE BY

14 CONTRACTOR.—The Secretary of Health and

15 Human Services shall enter into an agreement

16 with an entity not later than 60 days after the

17 date of enactment of the Social Security Act

18 Amendments of 1994, to distribute the ques19 tionnaire described in section 1862(b)(5)(D) of

20 the Social Security Act (as added by subpara21 graph (A)).

22 (C) NO MEDICARE SECONDARY PAYER DE23 NIAL BASED ON FAILURE TO COMPLETE QUES24 TIONNAIRE.—Section 1862(b)(2) (42 U.S.C.
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1 1395y(b)(2)) is amended by adding at the end

2 the following new subparagraph:

3 ‘‘(C) TREATMENT OF QUESTIONNAIRES.—

4 The Secretary may not fail to make payment

5 under subparagraph (A) solely on the ground

6 that an individual failed to complete a question7 naire concerning the existence of a primary

8 plan.’’.

9 (2) MANDATORY SCREENING BY PROVIDERS

10 AND SUPPLIERS UNDER PART B.—

11 (A) IN GENERAL.—Section 1862(b) (42

12 U.S.C. 1395y(b)) is amended by adding at the

13 end the following new paragraph:

14 ‘‘(6) SCREENING REQUIREMENTS FOR PROVID15 ERS AND SUPPLIERS.—

16 ‘‘(A) IN GENERAL.—Notwithstanding any

17 other provision of this title, no payment may be

18 made for any item or service furnished under

19 part B unless the entity furnishing such item or

20 service completes (to the best of its knowledge

21 and on the basis of information obtained from

22 the individual to whom the item or service is

23 furnished) the portion of the claim form relat24 ing to the availability of other health benefit

25 plans.
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1 ‘‘(B) PENALTIES.—An entity that know2 ingly, willfully, and repeatedly fails to complete

3 a claim form in accordance with subparagraph

4 (A) or provides inaccurate information relating

5 to the availability of other health benefit plans

6 on a claim form under such subparagraph shall

7 be subject to a civil money penalty of not to ex8 ceed $2,000 for each such incident. The provi9 sions of section 1128A (other than subsections

10 (a) and (b)) shall apply to a civil money penalty

11 under the previous sentence in the same man12 ner as such provisions apply to a penalty or

13 proceeding under section 1128A(a).’’.

14 (B) EFFECTIVE DATE.—The amendment

15 made by subparagraph (A) shall apply with re16 spect to items and services furnished on or

17 after the expiration of the 120-day period be18 ginning on the date of enactment of this Act.

19 (b) IMPROVEMENTS IN RECOVERY OF PAYMENTS

20 FROM PRIMARY PAYERS.—

21 (1) SUBMISSION OF REPORTS ON EFFORTS TO

22 RECOVER ERRONEOUS PAYMENTS.—

23 (A) FISCAL INTERMEDIARIES UNDER PART

24 A.—Section 1816 (42 U.S.C. 1396h) is amend-
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1 ed by adding at the end the following new sub2 section:

3 ‘‘(k) An agreement with an agency or organization

4 under this section shall require that such agency or orga5 nization submit an annual report to the Secretary describ6 ing the steps taken to recover payments made for items

7 or services for which payment has been or could be made

8 under a primary plan (as defined in section

9 1862(b)(2)(A)).’’.

10 (B) CARRIERS UNDER PART B.—Section

11 1842(b)(3) (42 U.S.C. 1395u(b)(3)) is amend12 ed—

13 (i) by striking ‘‘and’’ at the end of

14 subparagraph (G);

15 (ii) by striking ‘‘and’’ at the end of

16 subparagraph (H); and

17 (iii) by inserting after subparagraph

18 (H) the following new subparagraph:

19 ‘‘(I) will submit annual reports to the Secretary

20 describing the steps taken to recover payments made

21 under this part for items or services for which pay22 ment has been or could be made under a primary

23 plan (as defined in section 1862(b)(2)(A)); and’’.

24 (2) REQUIREMENTS UNDER CARRIER PERFORM25 ANCE EVALUATION PROGRAM.—
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1 (A) FISCAL INTERMEDIARIES UNDER PART

2 A.—Section 1816(f)(1)(A) (42 U.S.C.

3 1396h(f)(1)(A)) is amended by striking ‘‘proc4 essing’’ and inserting ‘‘processing (including the

5 agency’s or organization’s success in recovering

6 payments made under this title for services for

7 which payment has been or could be made

8 under a primary plan (as defined in section

9 1862(b)(2)(A)))’’.

10 (B) CARRIERS UNDER PART B.—Section

11 1842(b)(2) (42 U.S.C. 1395u(b)(2)) is amended

12 by adding at the end the following new sub13 paragraph:

14 ‘‘(D) In addition to any other standards and criteria

15 established by the Secretary for evaluating carrier per16 formance under this paragraph relating to avoiding erro17 neous payments, the carrier shall be subject to standards

18 and criteria relating to the carrier’s success in recovering

19 payments made under this part for items or services for

20 which payment has been or could be made under a pri21 mary plan (as defined in section 1862(b)(2)(A)).’’.

22 (3) DEADLINE FOR REIMBURSEMENT BY PRI23 MARY PLANS.—

24 (A) IN GENERAL.—Section

25 1862(b)(2)(B)(i) (42 U.S.C. 1395y(b)(2)(B)(i))
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1 is amended by adding at the end the following

2 sentence: ‘‘If reimbursement is not made to the

3 appropriate Trust Fund before the expiration of

4 the 60-day period that begins on the date such

5 notice or other information is received, the Sec6 retary may charge interest (beginning with the

7 date on which the notice or other information

8 is received) on the amount of the reimburse9 ment until reimbursement is made (at a rate

10 determined by the Secretary in accordance with

11 regulations of the Secretary of the Treasury

12 applicable to charges for late payments).’’.

13 (B) CONFORMING AMENDMENT.—The

14 heading of clause (i) of section 1862(b)(2)(B) is

15 amended to read as follows: ‘‘REPAYMENT RE16 QUIRED.—’’.

17 (C) EFFECTIVE DATE.—The amendments

18 made by this paragraph shall apply to payments

19 for items and services furnished on or after the

20 date of the enactment of this Act.

21 (4) EFFECTIVE DATE.—The amendments made

22 by paragraphs (1) and (2) shall apply to contracts

23 with fiscal intermediaries and carriers under title

24 XVIII of the Social Security Act for contract years

25 beginning with 1995.
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1 (c) MISCELLANEOUS AND TECHNICAL CORREC2 TIONS.—

3 (1) Effective as if included in the enactment of

4 OBRA–1993, section 1862(b)(1)(A) (42 U.S.C.

5 1395y(b)(1)(A)), as amended by section 13561(e)(1)

6 of OBRA–1993, is amended—

7 (A) in clause (i)(II), by striking ‘‘over (and

8 the individual’s spouse age 65 or older) who is

9 covered under the plan by virtue of the individ10 ual’s current employment status with an em11 ployer’’ and inserting ‘‘older (and the spouse

12 age 65 or older of any individual) who has cur13 rent employment status with an employer’’; and

14 (B) in clause (ii), by striking ‘‘or employee

15 organization that has 20 or more individuals in

16 current employment status’’ and inserting ‘‘that

17 has 20 or more employees’’.

18 (2) Effective as if included in the enactment of

19 OBRA–1993, section 1837(i) (42 U.S.C. 1395p(i))

20 is amended—

21 (A) by striking ‘‘as an active individual (as

22 those terms are defined in section

23 1862(b)(1)(B)(iv))’’ each place it appears in the

24 second sentence of paragraph (1), and the sec25 ond sentence of paragraph (2) and inserting
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1 ‘‘(as that term is defined in section

2 1862(b)(1)(B)(iv)) by reason of the individual’s

3 current employment status (or the current em4 ployment status of a family member of the indi5 vidual)’’;

6 (B) in paragraph (3)(B), by striking ‘‘as

7 an active individual in a large group health plan

8 (as such terms are defined in section

9 1862(b)(1)(B)(iv))’’ and inserting ‘‘in a large

10 group health plan (as that term is defined in

11 section 1862(b)(1)(B)(iv)) by reason of the in12 dividual’s current employment status (or the

13 current employment status of a family member

14 of the individual)’’;

15 (C) in the second sentence of paragraph

16 (2) (as amended by subparagraph (A)), by

17 striking ‘‘as an active individual’’ and inserting

18 ‘‘by reason of the individual’s current employ19 ment status (or the current employment status

20 of a family member of the individual)’’; and

21 (D) by inserting ‘‘status’’ after ‘‘current

22 employment’’ each place it appears in para23 graphs (1)(A), (2)(B), (2)(C), and (3)(A).
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1 (3) Effective as if included in the enactment of

2 OBRA–1993, the second sentence of section 1839(b)

3 (42 U.S.C. 1395r(b)) is amended—

4 (A) by inserting ‘‘status’’ after ‘‘current

5 employment’’, and

6 (B) by striking ‘‘as an active individual (as

7 those terms are defined in section

8 1862(b)(1)(B)(iv))’’ and inserting ‘‘(as that

9 term is defined in section 1862(b)(1)(B)(iv)) by

10 reason of the individual’s current employment

11 status (or the current employment status of a

12 family member of the individual)’’.

13 (4) Effective as if included in the enactment of

14 OBRA–1990, the sentence in section 1862(b)(1)(C)

15 added by section 4203(c)(1)(B) of OBRA–1990 is

16 amended by striking ‘‘clauses (i) and (ii)’’ and in17 serting ‘‘this subparagraph’’.

18 (5) Effective as if included in the enactment of

19 OBRA–1989, section 1862(b)(1)(C) is amended in

20 the matter after clause (ii), by striking ‘‘taking into

21 account that’’ and inserting ‘‘paying benefits second22 ary to this title when’’.

23 (6) Effective as if included in the enactment of

24 OBRA–1989, section 1862(b)(5)(C)(i) (42 U.S.C.

25 1395y(b)(5)(C)(i)) is amended by striking
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1 ‘‘6103(l)(12)(D)(iii)’’ and inserting

2 ‘‘6103(l)(12)(E)(iii)’’.

3 (7) Effective as if included in the enactment of

4 OBRA–1990, section 4203(c)(2) of such Act is

5 amended—

6 (A) by striking ‘‘the application of clause

7 (iii)’’ and inserting ‘‘the second sentence’’;

8 (B) by striking ‘‘on individuals’’ and all

9 that follows through ‘‘section 226A of such

10 Act’’;

11 (C) in clause (ii), by striking ‘‘clause’’ and

12 inserting ‘‘sentence’’;

13 (D) in clause (v), by adding ‘‘and’’ at the

14 end; and

15 (E) in clause (vi)—

16 (i) by inserting ‘‘of such Act’’ after

17 ‘‘1862(b)(1)(C)’’, and

18 (ii) by striking the period at the end

19 and inserting the following: ‘‘, without re20 gard to the number of employees covered

21 by such plans.’’.

22 (8) Effective as if included in the enactment of

23 OBRA–1990, section 4203(d) of OBRA–1990 is

24 amended by striking ‘‘this subsection’’ and inserting

25 ‘‘this section’’.
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1 (9) Effective as if included in the enactment of

2 OBRA–1993, section 13561(e)(1)(D) of OBRA–

3 1993 is amended—

4 (A) by inserting ‘‘effective as if included in

5 the enactment of OBRA–1989,’’ after ‘‘(D)’’,

6 and

7 (B) by striking ‘‘of each subparagraph’’.

8 (10) The amendment made by section

9 13561(e)(1)(G) of OBRA–1993, to the extent it re10 lates to the definition of large group health plan,

11 shall be effective as if included in the enactment of

12 OBRA–1989.

13 SEC. 152. PHYSICIAN OWNERSHIP AND REFERRAL.

14 (a) IN GENERAL.—Section 1877(f) (42 U.S.C.

15 1395nn) is amended—

16 (1) in the matter before paragraph (1), by in17 serting ‘‘, investment, and compensation’’ after

18 ‘‘ownership’’;

19 (2) in paragraph (2), by inserting ‘‘, or with a

20 compensation arrangement (as described in sub21 section (a)(2)(B)),’’ after ‘‘investment interest (as

22 described in subsection (a)(2)(A))’’;

23 (3) in paragraph (2), by inserting ‘‘interest or

24 who have such a compensation relationship with the

25 entity’’ before the period at the end;
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1 (4) in the fourth sentence, by striking ‘‘covered

2 items and’’ and inserting ‘‘designated health’’; and

3 (5) by striking the third and fifth sentences.

4 (b) RADIOLOGY SERVICES.—Section 1877(h)(6) (42

5 U.S.C. 1395nn(h)(6)), as amended by section 13562(a)(2)

6 of OBRA–1993, is amended—

7 (1) in subparagraph (D), by striking ‘‘or other

8 diagnostic services’’ and inserting ‘‘services, includ9 ing magnetic resonance imaging, computerized axial

10 tomography scans, and ultrasound services’’; and

11 (2) in subparagraphs (E), (F), and (H), by in12 serting ‘‘and supplies’’ before the period at the end.

13 (c) REVISION OF EFFECTIVE DATE EXCEPTION PRO14 VISION.—Section 13562(b)(2) of OBRA–1993 is amended

15 by striking subparagraphs (A) and (B) and inserting the

16 following:

17 ‘‘(A) the second sentence of subsection

18 (a)(2), and subsections (b)(2)(B) and (d)(2), of

19 section 1877 of the Social Security Act (as in

20 effect on the day before the date of the enact21 ment of this Act) shall apply instead of the cor22 responding provisions in section 1877 (as

23 amended by this Act);
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1 ‘‘(B) section 1877(b)(4) of the Social Se2 curity Act (as in effect on the day before the

3 date of the enactment of this Act) shall apply;

4 ‘‘(C) the requirements of section

5 1877(c)(2) of the Social Security Act (as

6 amended by this Act) shall not apply to any se7 curities of a corporation that meets the require8 ments of section 1877(c)(2) of the Social Secu9 rity Act (as in effect on the day before the date

10 of the enactment of this Act);

11 ‘‘(D) section 1877(e)(3) of the Social Secu12 rity Act (as amended by this Act) shall apply,

13 except that it shall not apply to any arrange14 ment that meets the requirements of subsection

15 (e)(2) or subsection (e)(3) of section 1877 of

16 the Social Security Act (as in effect on the day

17 before the date of the enactment of this Act);

18 ‘‘(E) the requirements of clauses (iv) and

19 (v) of section 1877(h)(4)(A), and of clause (i)

20 of section 1877(h)(4)(B), of the Social Security

21 Act (as amended by this Act) shall not apply;

22 and

23 ‘‘(F) section 1877(h)(4)(B) of the Social

24 Security Act (as in effect on the day before the

25 date of the enactment of this Act) shall apply
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1 instead of section 1877(h)(4)(A)(ii) of such Act

2 (as amended by this Act).’’.

3 (d) EFFECTIVE DATES.—

4 (1) The amendments made by subsections (a)

5 and (b) shall apply to referrals made on or after

6 January 1, 1995.

7 (2) The amendment made by subsection (c)

8 shall apply as if included in the enactment of

9 OBRA–1993.

10 SEC. 153. DEFINITION OF FMGEMS EXAMINATION FOR PAY11 MENT OF DIRECT GRADUATE MEDICAL EDU12 CATION.

13 (a) IN GENERAL.—Section 1886(h)(5)(E) (42 U.S.C.

14 1395ww(h)(5)(E)) is amended by inserting ‘‘or any suc15 cessor examination’’ after ‘‘Medical Sciences’’.

16 (b) EFFECTIVE DATE.—The amendment made by

17 subsection (a) shall apply as if included in the enactment

18 of the Consolidated Omnibus Budget Reconciliation Act

19 of 1985 (Public Law 99–272).

20 SEC. 154. QUALIFIED MEDICARE BENEFICIARY OUTREACH.

21 Not later than 1 year after the date of the enactment

22 of this Act, the Secretary of Health and Human Services

23 shall establish and implement a method for obtaining in24 formation from newly eligible medicare beneficiaries that

25 may be used to determine whether such beneficiaries may
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1 be eligible for medical assistance for medicare cost-sharing

2 under State medicaid plans as qualified medicare bene3 ficiaries, and for transmitting such information to the

4 State in which such a beneficiary resides.

5 SEC. 155. HOSPITAL AGREEMENTS WITH ORGAN PROCURE6 MENT ORGANIZATIONS.

7 (a) HOSPITAL AGREEMENTS.—

8 (1) IN GENERAL.—

9 (A) IDENTIFICATION OF ORGAN DO10 NORS.—Section 1138(a)(1)(A)(iii) (42 U.S.C.

11 1320b–8(a)(1)(A)(iii)) is amended to read as

12 follows:

13 ‘‘(iii) require that such hospital’s des14 ignated organ procurement agency (as defined

15 in paragraph (3)(B)) is notified of potential

16 organ donors;’’.

17 (B) AGREEMENTS WITH DESIGNATED

18 ORGAN PROCUREMENT AGENCIES.—Section

19 1138(a)(1) (42 U.S.C. 1320b–8(a)(1)) is

20 amended—

21 (i) by striking the period at the end of

22 subparagraph (B) and inserting ‘‘; and’’;

23 and

24 (ii) by adding at the end the following

25 new subparagraph:
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1 ‘‘(C) the hospital or rural primary care hospital

2 has an agreement (as defined in paragraph (3)(A))

3 only with such hospital’s designated organ procure4 ment agency.’’.

5 (C) WAIVER OF REQUIREMENTS RELATED

6 TO AGREEMENTS.—Section 1138(a) (42 U.S.C.

7 1320b–8(a)) is amended—

8 (i) by redesignating paragraph (2) as

9 paragraph (3); and

10 (ii) by inserting after paragraph (1)

11 the following new paragraph:

12 ‘‘(2)(A) The Secretary shall grant a waiver of the re13 quirements under subparagraphs (A)(iii) and (C) of para14 graph (1) to a hospital or rural primary care hospital de15 siring to enter into an agreement with an organ procure16 ment agency other than such hospital’s designated organ

17 procurement agency if the Secretary determines that—

18 ‘‘(i) the waiver is expected to increase organ do19 nation; and

20 ‘‘(ii) the waiver will assure equitable treatment

21 of patients referred for transplants within the serv22 ice area served by such hospital’s designated organ

23 procurement agency and within the service area

24 served by the organ procurement agency with which
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1 the hospital seeks to enter into an agreement under

2 the waiver.

3 ‘‘(B) In making a determination under subparagraph

4 (A), the Secretary may consider factors that would in5 clude, but not be limited to—

6 ‘‘(i) cost effectiveness;

7 ‘‘(ii) improvements in quality;

8 ‘‘(iii) whether there has been any change in a

9 hospital’s designated organ procurement agency due

10 to a change made on or after December 28, 1992,

11 in the definitions for metropolitan statistical areas

12 (as established by the Office of Management and

13 Budget); and

14 ‘‘(iv) the length and continuity of a hospital’s

15 relationship with an organ procurement agency other

16 than the hospital’s designated organ procurement

17 agency;

18 except that nothing in this subparagraph shall be con19 strued to permit the Secretary to grant a waiver that does

20 not meet the requirements of subparagraph (A).

21 ‘‘(C) Any hospital or rural primary care hospital

22 seeking a waiver under subparagraph (A) shall submit an

23 application to the Secretary containing such information

24 as the Secretary determines appropriate.

25 ‘‘(D) The Secretary shall—
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1 ‘‘(i) publish a public notice of any waiver appli2 cation received from a hospital or rural primary care

3 hospital under this paragraph within 30 days of re4 ceiving such application; and

5 ‘‘(ii) prior to making a final determination on

6 such application under subparagraph (A), offer in7 terested parties the opportunity to submit written

8 comments to the Secretary during the 60-day period

9 beginning on the date such notice is published.’’.

10 (D) DEFINITIONS.—Section 1138(a)(3)

11 (42 U.S.C. 1320b–8(a)(3)), as redesignated by

12 subparagraph (C), is amended to read as fol13 lows:

14 ‘‘(3) For purposes of this subsection—

15 ‘‘(A) the term ‘agreement’ means an agreement

16 described in section 371(b)(3)(A) of the Public

17 Health Service Act;

18 ‘‘(B) the term ‘designated organ procurement

19 agency’ means, with respect to a hospital or rural

20 primary care hospital, the organ procurement agency

21 designated pursuant to subsection (b) for the service

22 area in which such hospital is located; and

23 ‘‘(C) the term ‘organ’ means a human kidney,

24 liver, heart, lung, pancreas, and any other human
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1 organ or tissue specified by the Secretary for pur2 poses of this subsection.’’.

3 (2) EXISTING AGREEMENTS.—Any hospital or

4 rural primary care hospital which has an agreement

5 (as defined in section 1138(a)(3)(A) of the Social

6 Security Act) with an organ procurement agency

7 other than such hospital’s designated organ procure8 ment agency (as defined in section 1138(a)(3)(B) of

9 such Act) on the date of the enactment of this sec10 tion shall, if such hospital desires to continue such

11 agreement on and after the effective date of the

12 amendments made by paragraph (1), submit an ap13 plication to the Secretary for a waiver under section

14 1138(a)(2) of such Act not later than January 1,

15 1996, and such agreement may continue in effect

16 pending the Secretary’s determination with respect

17 to such application.

18 (3) EFFECTIVE DATE.—The amendments made

19 by paragraph (1) shall apply to hospitals and rural

20 primary care hospitals participating in the programs

21 under titles XVIII and XIX of the Social Security

22 Act beginning January 1, 1996.

23 (b) STUDY ON HOSPITAL AGREEMENTS WITH ORGAN

24 PROCUREMENT AGENCIES.—
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1 (1) IN GENERAL.—The Office of Technology

2 Assessment (referred to in this section as the

3 ‘‘OTA’’) shall, pursuant to the approval of the Tech4 nology Assessment Board of the OTA, conduct a

5 study to determine the efficacy and fairness of re6 quiring a hospital to enter into an agreement under

7 section 371(b)(3)(A) of the Public Health Service

8 Act with the organ procurement agency designated

9 pursuant to section 1138(b) of the Social Security

10 Act for the service area in which such hospital is lo11 cated and the impact of such requirement on the ef12 ficacy and fairness of organ procurement and dis13 tribution.

14 (2) REPORT.—Not later than 2 years after the

15 date of the enactment of this Act, the OTA shall

16 complete the study required under paragraph (1)

17 and prepare and submit to the Committee on Fi18 nance and the Committee on Labor and Human Re19 sources of the Senate and the Committee on Ways

20 and Means and the Committee on Energy and Com21 merce of the House of Representatives a report con22 taining the findings of such study and the implica23 tions of such findings with respect to policies affect24 ing organ procurement and distribution.
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1 SEC. 156. PEER REVIEW ORGANIZATIONS.

2 (a) REPEAL OF PRO PRECERTIFICATION REQUIRE3 MENT FOR CERTAIN SURGICAL PROCEDURES.—

4 (1) IN GENERAL.—Section 1164 (42 U.S.C.

5 1320c–13) is repealed.

6 (2) CONFORMING AMENDMENTS.—

7 (A) Section 1154 (42 U.S.C. 1320c–3) is

8 amended—

9 (i) in subsection (a), by striking para10 graph (12), and

11 (ii) in subsection (d), by striking

12 ‘‘(and except as provided in section

13 1164)’’.

14 (B) Section 1833 (42 U.S.C. 1395l) is

15 amended—

16 (i) in subsection (a)(1)(D)(i), by strik17 ing ‘‘, or for tests furnished in connection

18 with obtaining a second opinion required

19 under section 1164(c)(2) (or a third opin20 ion, if the second opinion was in disagree21 ment with the first opinion)’’;

22 (ii) in subsection (a)(1), by striking

23 subparagraph (G);

24 (iii) in subsection (a)(2)(A), by strik25 ing ‘‘, to items and services (other than

26 clinical diagnostic laboratory tests) fur-
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1 nished in connection with obtaining a sec2 ond opinion required under section

3 1164(c)(2) (or a third opinion, if the sec4 ond opinion was in disagreement with the

5 first opinion),’’;

6 (iv) in subsection (a)(2)(D)(i)—

7 (I) by striking ‘‘basis,’’ and in8 serting ‘‘basis or’’, and

9 (II) by striking ‘‘, or for tests

10 furnished in connection with obtaining

11 a second opinion required under sec12 tion 1164(c)(2) (or a third opinion, if

13 the second opinion was in disagree14 ment with the first opinion)’’;

15 (v) in subsection (a)(3), by striking

16 ‘‘and for items and services furnished in

17 connection with obtaining a second opinion

18 required under section 1164(c)(2), or a

19 third opinion, if the second opinion was in

20 disagreement with the first opinion’’; and

21 (vi) in the first sentence of subsection

22 (b), by striking ‘‘(4)’’ and all that follows

23 through ‘‘and (5)’’ and inserting ‘‘and

24 (4)’’.
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1 (C) Section 1834(g)(1)(B) (42 U.S.C.

2 1395m(g)(1)(B)) is amended by striking ‘‘and

3 for items and services furnished in connection

4 with obtaining a second opinion required under

5 section 1164(c)(2), or a third opinion, if the

6 second opinion was in disagreement with the

7 first opinion’’.

8 (D) Section 1862(a) (42 U.S.C. 1395y(a))

9 is amended—

10 (i) by adding ‘‘or’’ at the end of para11 graph (14),

12 (ii) by striking ‘‘; or’’ at the end of

13 paragraph (15) and inserting a period, and

14 (iii) by striking paragraph (16).

15 (E) The third sentence of section

16 1866(a)(2)(A) (42 U.S.C. 1395w(a)(2)(A)) is

17 amended by striking ‘‘, with respect to items

18 and services furnished in connection with ob19 taining a second opinion required under section

20 1164(c)(2) (or a third opinion, if the second

21 opinion was in disagreement with the first opin22 ion),’’.

23 (3) EFFECTIVE DATE.—The amendments made

24 by this subsection shall apply to services provided on

25 or after the date of the enactment of this Act.
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1 (b) MISCELLANEOUS AND TECHNICAL CORREC2 TIONS.—(1) The third sentence of section 1156(b)(1) (42

3 U.S.C. 1320c–5(b)(1)) is amended by striking ‘‘whehter’’

4 and inserting ‘‘whether’’.

5 (2)(A) Section 1154(a)(9)(B) (42 U.S.C. 1320c–

6 3(a)(9)(B)) is amended to read as follows:

7 ‘‘(B) If the organization finds, after reasonable

8 notice to and opportunity for discussion with the

9 physician or practitioner concerned, that the physi10 cian or practitioner has furnished services in viola11 tion of section 1156(a) and the organization deter12 mines that the physician or practitioner should enter

13 into a corrective action plan under section

14 1156(b)(1), the organization shall notify the State

15 board or boards responsible for the licensing or dis16 ciplining of the physician or practitioner of its find17 ing and of any action taken as a result of the find18 ing.’’.

19 (B) Subparagraph (D) of section 1160(b)(1) (42

20 U.S.C. 1320c–9(b)(1)) is amended to read as follows:

21 ‘‘(D) to provide notice in accordance with

22 section 1154(a)(9)(B);’’.

23 (3) Section 4205(d)(2)(B) of OBRA–1990 is amend24 ed by striking ‘‘amendments’’ and inserting ‘‘amend25 ment’’.
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1 (4) Section 1160(d) (42 U.S.C. 1320c–9(d)) is

2 amended by striking ‘‘subpena’’ and inserting ‘‘subpoena’’.

3 (5) Section 4205(e)(2) of OBRA–1990 is amended

4 by striking ‘‘amendments’’ and inserting ‘‘amendment’’

5 and by striking ‘‘all’’.

6 (6)(A) Except as provided in subparagraph (B), the

7 amendments made by this subsection shall take effect as

8 if included in the enactment of OBRA–1990.

9 (B) The amendments made by paragraph (2) (relat10 ing to the requirement on reporting of information to

11 State boards) shall take effect on the date of the enact12 ment of this Act.

13 SEC. 157. HEALTH MAINTENANCE ORGANIZATIONS.

14 (a) REVISIONS IN THE PAYMENT METHODOLOGY

15 FOR RISK CONTRACTORS.—Section 4204(b) of OBRA–

16 1990 is amended to read as follows:

17 ‘‘(b) REVISIONS IN THE PAYMENT METHODOLOGY

18 FOR RISK CONTRACTORS.—(1)(A) Not later than October

19 1, 1995, the Secretary of Health and Human Services (in

20 this subsection referred to as the ‘Secretary’) shall submit

21 a proposal to the Congress that provides for revisions to

22 the payment method to be applied in years beginning with

23 1997 for organizations with a risk-sharing contract under

24 section 1876(g) of the Social Security Act.
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1 ‘‘(B) In proposing the revisions required under sub2 paragraph (A), the Secretary shall consider—

3 ‘‘(i) the difference in costs associated with med4 icare beneficiaries with differing health status and

5 demographic characteristics; and

6 ‘‘(ii) the effects of using alternative geographic

7 classifications on the determinations of costs associ8 ated with beneficiaries residing in different areas.

9 ‘‘(2) Not later than 3 months after the date of sub10 mittal of the proposal under paragraph (1), the Comptrol11 ler General shall review the proposal and shall report to

12 Congress on the appropriateness of the proposed modifica13 tions.’’.

14 (b) MISCELLANEOUS AND TECHNICAL CORREC15 TIONS.—(1) Section 1876(a)(3) (42 U.S.C.

16 1395mm(a)(3)) is amended by striking ‘‘subsection

17 (c)(7)’’ and inserting ‘‘subsections (c)(2)(B)(ii) and

18 (c)(7)’’.

19 (2) Section 4204(c)(3) of OBRA–1990 is amended

20 by striking ‘‘for 1991’’ and inserting ‘‘for years beginning

21 with 1991’’.

22 (3) Section 4204(d)(2) of OBRA–1990 is amended

23 by striking ‘‘amendment’’ and inserting ‘‘amendments’’.
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1 (4) Section 1876(a)(1)(E)(ii)(I) (42 U.S.C.

2 1395mm(a)(1)(E)(ii)(I)) is amended by striking the

3 comma after ‘‘contributed to’’.

4 (5) Section 4204(e)(2) of OBRA–1990 is amended

5 by striking ‘‘(which has a risk-sharing contract under sec6 tion 1876 of the Social Security Act)’’.

7 (6) Section 4204(f)(4) of OBRA–1990 is amended by

8 striking ‘‘final’’.

9 (7) Section 1862(b)(3)(C) (42 U.S.C.

10 1395y(b)(3)(C)) is amended—

11 (A) in the heading, by striking ‘‘PLAN’’ and in12 serting ‘‘PLAN OR A LARGE GROUP HEALTH PLAN’’;

13 (B) by striking ‘‘group health plan’’ and insert14 ing ‘‘group health plan or a large group health

15 plan’’;

16 (C) by striking ‘‘, unless such incentive is also

17 offered to all individuals who are eligible for cov18 erage under the plan’’; and

19 (D) by striking ‘‘the first sentence of subsection

20 (a) and other than subsection (b)’’ and inserting

21 ‘‘subsections (a) and (b)’’.

22 (8) The amendments made by this subsection shall

23 take effect as if included in the enactment of OBRA–1990.
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1 SEC. 158. HOME HEALTH AGENCIES.

2 (a) USE OF MOST CURRENT DATA IN DETERMINING

3 WAGE INDEX.—

4 (1) IN GENERAL.—Section 1861(v)(1)(L)(iii)

5 (42 U.S.C. 1395x(v)(1)(L)(iii)) is amended by strik6 ing ‘‘as of such date to’’ and inserting ‘‘and deter7 mined using the survey of the most recent available

8 wages and wage-related costs of’’.

9 (2) EFFECTIVE DATE.—The amendment made

10 by paragraph (1) shall apply with respect to cost re11 porting periods beginning on or after July 1, 1996.

12 (b) CLARIFICATION OF EXTENSION OF WAIVER OF

13 LIABILITY.—

14 (1) IN GENERAL.—The second sentence of sec15 tion 9205 of the Consolidated Omnibus Budget Rec16 onciliation Act of 1985 is amended by striking ‘‘No17 vember 1, 1990’’ and inserting ‘‘December 31,

18 1995’’.

19 (2) EFFECTIVE DATE.—The amendment made

20 by paragraph (1) shall take effect as if included in

21 the enactment of OBRA–1990.

22 SEC. 159. PERMANENT EXTENSION OF AUTHORITY TO CON23 TRACT WITH FISCAL INTERMEDIARIES AND

24 CARRIERS ON OTHER THAN A COST BASIS.

25 (a) IN GENERAL.—Section 2326(a) of the Deficit Re26 duction Act of 1984, as amended by section 6215 of
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1 OBRA–1989, is amended in the third sentence by striking

2 ‘‘during such period’’ and inserting ‘‘beginning with fiscal

3 year 1990 and any subsequent fiscal year’’.

4 (b) EFFECTIVE DATE.—The amendment made by

5 subsection (a) shall apply beginning with fiscal year 1994.

6 SEC. 160. MISCELLANEOUS AND TECHNICAL CORRECTIONS.

7 (a) SURVEY AND CERTIFICATION REQUIREMENTS.—

8 (1) Section 1864 (42 U.S.C. 1395aa) is amended—

9 (A) in subsection (e), by striking ‘‘title’’ and in10 serting ‘‘title (other than any fee relating to section

11 353 of the Public Health Service Act)’’; and

12 (B) in the first sentence of subsection (a), by

13 striking ‘‘1861(s) or’’ and all that follows through

14 ‘‘Service Act,’’ and inserting ‘‘1861(s),’’.

15 (2) An agreement made by the Secretary of Health

16 and Human Services with a State under section 1864(a)

17 of the Social Security Act may include an agreement that

18 the services of the State health agency or other appro19 priate State agency (or the appropriate local agencies) will

20 be utilized by the Secretary for the purpose of determining

21 whether a laboratory meets the requirements of section

22 353 of the Public Health Service Act.

23 (b) HOME DIALYSIS DEMONSTRATION TECHNICAL

24 CORRECTIONS.—Section 4202 of OBRA–1990 is amend25 ed—
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1 (1) in subsection (b)(1)(A), by striking ‘‘home

2 hemodialysis staff assistant’’ and inserting ‘‘quali3 fied home hemodialysis staff assistant (as described

4 in subsection (d))’’;

5 (2) in subsection (b)(2)(B)(ii)(I), by striking

6 ‘‘(as adjusted to reflect differences in area wage

7 levels)’’;

8 (3) in subsection (c)(1)(A), by striking

9 ‘‘skilled’’; and

10 (4) in subsection (c)(1)(E), by striking ‘‘(b)(4)’’

11 and inserting ‘‘(b)(2)’’.

12 (c) TECHNICAL CORRECTION TO REVISIONS OF COV13 ERAGE FOR IMMUNOSUPPRESSIVE DRUG THERAPY.—The

14 Secretary of Health and Human Services may administer

15 section 1861(s)(2)(J) of the Social Security Act (42

16 U.S.C. 1395x(s)(2)(J)) in a manner such that the months

17 of coverage of drugs described in such section are provided

18 consecutively, so long as the total number of months of

19 coverage provided is the same as the number of months

20 described in such section.

21 (d) OTHER MISCELLANEOUS AND TECHNICAL PRO22 VISIONS.—(1) Section 1833 (42 U.S.C. 1395l) is amended

23 by redesignating the subsection (r) added by section

24 4206(b)(2) of OBRA–1990 as subsection (s).
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1 (2) Section 1866(f)(1) (42 U.S.C. 1395cc(f)(1)) is

2 amended by striking ‘‘1833(r)’’ and inserting ‘‘1833(s)’’.

3 (3) Section 4201(d)(2) of OBRA–1990 is amended

4 by striking ‘‘(B) by striking’’, ‘‘(C) by striking’’, and ‘‘(3)

5 by adding’’ and inserting ‘‘(i) by striking’’, ‘‘(ii) by strik6 ing’’, and ‘‘(B) by adding’’, respectively.

7 (4) The section following section 4206 of OBRA–

8 1990 is amended by striking ‘‘SEC. 4027.’’ and inserting

9 ‘‘SEC. 4207.’’, and in this subtitle is referred to as section

10 4207 of OBRA–1990.

11 (5)(A) Section 4207(a)(1) of OBRA–1990 is amend12 ed by adding closing quotation marks and a period after

13 ‘‘such review.’’.

14 (B) Section 4207(a)(4) of OBRA–1990 is amended

15 by striking ‘‘this subsection’’ and inserting ‘‘paragraphs

16 (2) and (3)’’.

17 (C) Section 4207(b)(1) of OBRA–1990 is amended

18 by striking ‘‘section 3(7)’’ and inserting ‘‘section

19 601(a)(1)’’.

20 (6) Section 2355(b)(1)(B) of the Deficit Reduction

21 Act of 1984, as amended by section 4207(b)(4)(B)(ii) of

22 OBRA–1990, is amended—

23 (A) by striking ‘‘12907(c)(4)(A)’’ and inserting

24 ‘‘4207(b)(4)(B)(i)’’, and
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1 (B) by striking ‘‘feasibilitly’’ and inserting ‘‘fea2 sibility’’.

3 (7) Section 4207(b)(4)(B)(iii)(III) of OBRA–1990 is

4 amended by striking the period at the end and inserting

5 a semicolon.

6 (8) Subsections (c)(3) and (e) of section 2355 of the

7 Deficit Reduction Act of 1984, as amended by section

8 4207(b)(4)(B) of OBRA–1990, are each amended by

9 striking ‘‘12907(c)(4)(A)’’ each place it appears and in10 serting ‘‘4207(b)(4)(B)’’.

11 (9) Section 4207(c)(2) of OBRA–1990 is amended

12 by striking ‘‘the Committee on Ways and Means’’ each

13 place it appears and inserting ‘‘the Committees on Ways

14 and Means and Energy and Commerce’’.

15 (10) Section 4207(d) of OBRA–1990 is amended by

16 redesignating the second paragraph (3) (relating to effec17 tive date) as paragraph (4).

18 (11) Section 4207(i)(2) of OBRA–1990 is amend19 ed—

20 (A) by striking the period at the end of clause

21 (iii) and inserting a semicolon, and

22 (B) in clause (v), by striking ‘‘residents’’ and

23 inserting ‘‘patients’’.
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1 (12) Section 4207(j) of OBRA–1990 is amended by

2 striking ‘‘title’’ each place it appears and inserting ‘‘sub3 title’’.

4 Subtitle D—Provisions Relating to

5 Medicare Supplemental Insur6 ance Policies

7 SEC. 171. STANDARDS FOR MEDICARE SUPPLEMENTAL IN8 SURANCE POLICIES.

9 (a) SIMPLIFICATION OF MEDICARE SUPPLEMENTAL

10 POLICIES.—

11 (1) Section 4351 of OBRA–1990 is amended by

12 striking ‘‘(a) IN GENERAL.—’’.

13 (2) Section 1882(p) (42 U.S.C. 1395ss(p)) is

14 amended—

15 (A) in paragraph (1)(A)—

16 (i) by striking ‘‘promulgates’’ and in17 serting ‘‘changes the revised NAIC Model

18 Regulation (described in subsection (m)) to

19 incorporate’’,

20 (ii) by striking ‘‘(such limitations, lan21 guage, definitions, format, and standards

22 referred to collectively in this subsection as

23 ‘NAIC standards’),’’, and

24 (iii) by striking ‘‘included a reference

25 to the NAIC standards’’ and inserting
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1 ‘‘were a reference to the revised NAIC

2 Model Regulation as changed under this

3 subparagraph (such changed regulation re4 ferred to in this section as the ‘1991 NAIC

5 Model Regulation’)’’;

6 (B) in paragraph (1)(B)—

7 (i) by striking ‘‘promulgate NAIC

8 standards’’ and inserting ‘‘make the

9 changes in the revised NAIC Model Regu10 lation’’,

11 (ii) by striking ‘‘limitations, language,

12 definitions, format, and standards de13 scribed in clauses (i) through (iv) of such

14 subparagraph (in this subsection referred

15 to collectively as ‘Federal standards’)’’ and

16 inserting ‘‘a regulation’’, and

17 (iii) by striking ‘‘included a reference

18 to the Federal standards’’ and inserting

19 ‘‘were a reference to the revised NAIC

20 Model Regulation as changed by the Sec21 retary under this subparagraph (such

22 changed regulation referred to in this sec23 tion as the ‘1991 Federal Regulation’)’’;

24 (C) in paragraph (1)(C)(i), by striking

25 ‘‘NAIC standards or the Federal standards’’
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1 and inserting ‘‘1991 NAIC Model Regulation or

2 1991 Federal Regulation’’;

3 (D) in paragraphs (1)(C)(ii)(I), (1)(E),

4 (2), and (9)(B), by striking ‘‘NAIC or Federal

5 standards’’ and inserting ‘‘1991 NAIC Model

6 Regulation or 1991 Federal Regulation’’;

7 (E) in paragraph (2)(C), by striking

8 ‘‘(5)(B)’’ and inserting ‘‘(4)(B)’’;

9 (F) in paragraph (4)(A)(i), by inserting

10 ‘‘or paragraph (6)’’ after ‘‘(B)’’;

11 (G) in paragraph (4), by striking ‘‘applica12 ble standards’’ each place it appears and insert13 ing ‘‘applicable 1991 NAIC Model Regulation

14 or 1991 Federal Regulation’’;

15 (H) in paragraph (6), by striking ‘‘in re16 gard to the limitation of benefits described in

17 paragraph (4)’’ and inserting ‘‘described in

18 clauses (i) through (iii) of paragraph (1)(A)’’;

19 (I) in paragraph (7), by striking ‘‘policy20 holder’’ and inserting ‘‘policyholders’’;

21 (J) in paragraph (8), by striking ‘‘after the

22 effective date of the NAIC or Federal standards

23 with respect to the policy, in violation of the

24 previous requirements of this subsection’’ and

25 inserting ‘‘on and after the effective date speci-
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1 fied in paragraph (1)(C) (but subject to para2 graph (10)), in violation of the applicable 1991

3 NAIC Model Regulation or 1991 Federal Regu4 lation insofar as such regulation relates to the

5 requirements of subsection (o) or (q) or clause

6 (i), (ii), or (iii) of paragraph (1)(A)’’;

7 (K) in paragraph (9), by adding at the end

8 the following new subparagraph:

9 ‘‘(D) Subject to paragraph (10), this paragraph shall

10 apply to sales of policies occurring on or after the effective

11 date specified in paragraph (1)(C).’’; and

12 (L) in paragraph (10), by striking ‘‘this

13 subsection’’ and inserting ‘‘paragraph

14 (1)(A)(i)’’.

15 (b) GUARANTEED RENEWABILITY.—Section 1882(q)

16 (42 U.S.C. 1395ss(q)) is amended—

17 (1) in paragraph (2), by striking ‘‘paragraph

18 (2)’’ and inserting ‘‘paragraph (4)’’, and

19 (2) in paragraph (4), by striking ‘‘the succeed20 ing issuer’’ and inserting ‘‘issuer of the replacement

21 policy’’.

22 (c) ENFORCEMENT OF STANDARDS.—

23 (1) Section 1882(a)(2) (42 U.S.C.

24 1395ss(a)(2)) is amended—
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1 (A) in subparagraph (A), by striking

2 ‘‘NAIC standards or the Federal standards’’

3 and inserting ‘‘1991 NAIC Model Regulation or

4 1991 Federal Regulation’’, and

5 (B) by striking ‘‘after the effective date of

6 the NAIC or Federal standards with respect to

7 the policy’’ and inserting ‘‘on and after the ef8 fective date specified in subsection (p)(1)(C)’’.

9 (2) The sentence in section 1882(b)(1) added

10 by section 4353(c)(5) of OBRA–1990 is amended—

11 (A) by striking ‘‘The report’’ and inserting

12 ‘‘Each report’’,

13 (B) by inserting ‘‘and requirements’’ after

14 ‘‘standards’’,

15 (C) by striking ‘‘and’’ after ‘‘compliance,’’,

16 and

17 (D) by striking the comma after ‘‘Commis18 sioners’’.

19 (3) Section 1882(g)(2)(B) (42 U.S.C.

20 1395ss(g)(2)(B)) is amended by striking ‘‘Panel’’

21 and inserting ‘‘Secretary’’.

22 (4) Section 1882(b)(1) (42 U.S.C.

23 1395ss(b)(1)) is amended by striking ‘‘the the Sec24 retary’’ and inserting ‘‘the Secretary’’.

25 (d) PREVENTING DUPLICATION.—
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1 (1) Section 1882(d)(3)(A) (42 U.S.C.

2 1395ss(d)(3)(A)) is amended—

3 (A) by amending the first sentence to read

4 as follows:

5 ‘‘(i) It is unlawful for a person to sell or issue to an

6 individual entitled to benefits under part A or enrolled

7 under part B of this title—

8 ‘‘(I) a health insurance policy with knowledge

9 that the policy duplicates health benefits to which

10 the individual is otherwise entitled under this title or

11 title XIX,

12 ‘‘(II) a medicare supplemental policy with

13 knowledge that the individual is entitled to benefits

14 under another medicare supplemental policy, or

15 ‘‘(III) a health insurance policy (other than a

16 medicare supplemental policy) with knowledge that

17 the policy duplicates health benefits to which the in18 dividual is otherwise entitled, other than benefits to

19 which the individual is entitled under a requirement

20 of State or Federal law.’’;

21 (B) by designating the second sentence as

22 clause (ii) and, in such clause, by striking ‘‘the

23 previous sentence’’ and inserting ‘‘clause (i)’’;

24 (C) by designating the third sentence as

25 clause (iii) and, in such clause—
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1 (i) by striking ‘‘the previous sentence’’

2 and inserting ‘‘clause (i) with respect to

3 the sale of a medicare supplemental pol4 icy’’, and

5 (ii) by striking ‘‘and the statement’’

6 and all that follows up to the period at the

7 end; and

8 (D) by striking the last sentence.

9 (2) Section 1882(d)(3)(B) (42 U.S.C.

10 1395ss(d)(3)(B)) is amended—

11 (A) in clause (ii)(II), by striking ‘‘65 years

12 of age or older’’,

13 (B) in clause (iii)(I), by striking ‘‘another

14 medicare’’ and inserting ‘‘a medicare’’,

15 (C) in clause (iii)(I), by striking ‘‘such a

16 policy’’ and inserting ‘‘a medicare supplemental

17 policy’’,

18 (D) in clause (iii)(II), by striking ‘‘another

19 policy’’ and inserting ‘‘a medicare supplemental

20 policy’’, and

21 (E) by amending subclause (III) of clause

22 (iii) to read as follows:

23 ‘‘(III) If the statement required by clause (i) is ob24 tained and indicates that the individual is entitled to any

25 medical assistance under title XIX, the sale of the policy
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1 is not in violation of clause (i) (insofar as such clause re2 lates to such medical assistance), if (aa) a State medicaid

3 plan under such title pays the premiums for the policy,

4 (bb) in the case of a qualified medicare beneficiary de5 scribed in section 1905(p)(1), the policy provides for cov6 erage of outpatient prescription drugs, or (cc) the only

7 medical assistance to which the individual is entitled under

8 the State plan is medicare cost sharing described in sec9 tion 1905(p)(3)(A)(ii).’’.

10 (3)(A) Section 1882(d)(3)(C) (42 U.S.C.

11 1395ss(d)(3)(C)) is amended—

12 (i) by striking ‘‘the selling’’ and inserting

13 ‘‘(i) the sale or issuance’’, and

14 (ii) by inserting before the period at the

15 end the following: ‘‘, (ii) the sale or issuance of

16 a policy or plan described in subparagraph

17 (A)(i)(I) (other than a medicare supplemental

18 policy to an individual entitled to any medical

19 assistance under title XIX) under which all the

20 benefits are fully payable directly to or on be21 half of the individual without regard to other

22 health benefit coverage of the individual but

23 only if (for policies sold or issued more than 60

24 days after the date the statements are pub25 lished or promulgated under subparagraph (D))
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1 there is disclosed in a prominent manner as

2 part of (or together with) the application the

3 applicable statement (specified under subpara4 graph (D)) of the extent to which benefits pay5 able under the policy or plan duplicate benefits

6 under this title, or (iii) the sale or issuance of

7 a policy or plan described in subparagraph

8 (A)(i)(III) under which all the benefits are fully

9 payable directly to or on behalf of the individual

10 without regard to other health benefit coverage

11 of the individual’’.

12 (B) Section 1882(d)(3) (42 U.S.C.

13 1395ss(d)(3)) is amended by adding at the end the

14 following:

15 ‘‘(D)(i) If—

16 ‘‘(I) within the 90-day period beginning on the

17 date of the enactment of this subparagraph, the Na18 tional Association of Insurance Commissioners devel19 ops (after consultation with consumer and insurance

20 industry representatives) and submits to the Sec21 retary a statement for each of the types of health in22 surance policies (other than medicare supplemental

23 policies and including, but not limited to, as sepa24 rate types of policies, policies paying directly to the

25 beneficiary fixed, cash benefits, and policies that
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1 limit benefit payments to specific diseases) which are

2 sold or issued to persons entitled to health benefits

3 under this title, of the extent to which benefits pay4 able under the policy or plan duplicate benefits

5 under this title, and

6 ‘‘(II) the Secretary approves all the statements

7 submitted as meeting the requirements of subclause

8 (I),

9 each such statement shall be (for purposes of subpara10 graph (C)) the statement specified under this subpara11 graph for the type of policy involved. The Secretary shall

12 review and approve (or disapprove) all the statements sub13 mitted under subclause (I) within 30 days after the date

14 of their submittal. Upon approval of such statements, the

15 Secretary shall publish such statements.

16 ‘‘(ii) If the Secretary does not approve the statements

17 under clause (i) or the statements are not submitted with18 in the 90-day period specified in such clause, the Secretary

19 shall promulgate (after consultation with consumer and

20 insurance industry representatives and not later than 90

21 days after the date of disapproval or the end of such 90-

22 day period (as the case may be)) a statement for each

23 of the types of health insurance policies (other than medi24 care supplemental policies and including, but not limited

25 to, as separate types of policies, policies paying directly
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1 to the beneficiary fixed, cash benefits, and policies that

2 limit benefit payments to specific diseases) which are sold

3 or issued to persons entitled to health benefits under this

4 title, of the extent to which benefits payable under the pol5 icy or plan duplicate benefits under this title, and each

6 such statement shall be (for purposes of subparagraph

7 (C)) the statement specified under this subparagraph for

8 the type of policy involved.’’.

9 (C) The requirement of a disclosure under sec10 tion 1882(d)(3)(C)(ii) of the Social Security Act

11 shall not apply to an application made for a policy

12 or plan before 60 days after the date the Secretary

13 of Health and Human Services publishes or promul14 gates all the statements under section

15 1882(d)(3)(D) of such Act.

16 (4) Subparagraphs (A) and (B) of section

17 1882(q)(5) are amended by striking ‘‘of the Social

18 Security Act’’.

19 (e) LOSS RATIOS AND REFUNDS OF PREMIUMS.—

20 (1) Section 1882(r) (42 U.S.C. 1395ss(r)) is

21 amended—

22 (A) in paragraph (1), by striking ‘‘or sold’’

23 and inserting ‘‘or renewed (or otherwise provide

24 coverage after the date described in subsection

25 (p)(1)(C))’’;
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1 (B) in paragraph (1)(A), by inserting ‘‘for

2 periods after the effective date of these provi3 sions’’ after ‘‘the policy can be expected’’;

4 (C) in paragraph (1)(A), by striking

5 ‘‘Commissioners,’’ and inserting ‘‘Commis6 sioners)’’;

7 (D) in paragraph (1)(B), by inserting be8 fore the period at the end the following: ‘‘,

9 treating policies of the same type as a single

10 policy for each standard package’’;

11 (E) by adding at the end of paragraph (1)

12 the following: ‘‘For the purpose of calculating

13 the refund or credit required under paragraph

14 (1)(B) for a policy issued before the date speci15 fied in subsection (p)(1)(C), the refund or cred16 it calculation shall be based on the aggregate

17 benefits provided and premiums collected under

18 all such policies issued by an insurer in a State

19 (separated as to individual and group policies)

20 and shall be based only on aggregate benefits

21 provided and premiums collected under such

22 policies after the date specified in section

23 171(m)(4) of the Social Security Act Amend24 ments of 1994.’’;
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1 (F) in the first sentence of paragraph

2 (2)(A), by striking ‘‘by policy number’’ and in3 serting ‘‘by standard package’’;

4 (G) by striking the second sentence of

5 paragraph (2)(A) and inserting the following:

6 ‘‘Paragraph (1)(B) shall not apply to a policy

7 until 12 months following issue.’’;

8 (H) in the last sentence of paragraph

9 (2)(A), by striking ‘‘in order’’ and all that fol10 lows through ‘‘are effective’’;

11 (I) by adding at the end of paragraph

12 (2)(A), the following new sentence: ‘‘In the case

13 of a policy issued before the date specified in

14 subsection (p)(1)(C), paragraph (1)(B) shall

15 not apply until 1 year after the date specified

16 in section 171(m)(4) of the Social Security Act

17 Amendments of 1994.’’;

18 (J) in paragraph (2), by striking ‘‘policy

19 year’’ each place it appears and inserting ‘‘cal20 endar year’’;

21 (K) in paragraph (4), by striking ‘‘Feb22 ruary’’, ‘‘disllowance’’, ‘‘loss-ratios’’ each place

23 it appears, and ‘‘loss-ratio’’ and inserting ‘‘Oc24 tober’’, ‘‘disallowance’’, ‘‘loss ratios’’, and ‘‘loss

25 ratio’’, respectively;
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1 (L) in paragraph (6)(A), by striking ‘‘is2 sues a policy in violation of the loss ratio re3 quirements of this subsection’’ and ‘‘such viola4 tion’’ and inserting ‘‘fails to provide refunds or

5 credits as required in paragraph (1)(B)’’ and

6 ‘‘policy issued for which such failure occurred’’,

7 respectively; and

8 (M) in paragraph (6)(B), by striking ‘‘to

9 policyholders’’ and inserting ‘‘to the policy10 holder or, in the case of a group policy, to the

11 certificate holder’’.

12 (2) Section 1882(b)(1) (42 U.S.C.

13 1395ss(b)(1)) is amended, in the matter after sub14 paragraph (H), by striking ‘‘subsection (F)’’ and in15 serting ‘‘subparagraph (F)’’.

16 (3) Section 4355(d) of OBRA–1990 is amended

17 by striking ‘‘sold or issued’’ and all that follows and

18 inserting ‘‘issued or renewed (or otherwise providing

19 coverage after the date described in section

20 1882(p)(1)(C) of the Social Security Act) on or after

21 the date specified in section 1882(p)(1)(C) of the

22 Social Security Act.’’.

23 (f) TREATMENT OF HMO’S.—

24 (1) Section 1882(g)(1) (42 U.S.C.

25 1395ss(g)(1)) is amended by striking ‘‘a health
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1 maintenance organization or other direct service or2 ganization’’ and all that follows through ‘‘1833’’ and

3 inserting ‘‘an eligible organization (as defined in sec4 tion 1876(b)) if the policy or plan provides benefits

5 pursuant to a contract under section 1876 or an ap6 proved demonstration project described in section

7 603(c) of the Social Security Amendments of 1983,

8 section 2355 of the Deficit Reduction Act of 1984,

9 or section 9412(b) of the Omnibus Budget Reconcili10 ation Act of 1986, or, during the period beginning

11 on the date specified in subsection (p)(1)(C) and

12 ending on December 31, 1995, a policy or plan of

13 an organization if the policy or plan provides bene14 fits pursuant to an agreement under section

15 1833(a)(1)(A)’’.

16 (2) Section 4356(b) of OBRA–1990 is amended

17 by striking ‘‘on the date of the enactment of this

18 Act’’ and inserting ‘‘on the date specified in section

19 1882(p)(1)(C) of the Social Security Act’’.

20 (g) PRE-EXISTING CONDITION LIMITATIONS.—Sec21 tion 1882(s) (42 U.S.C. 1395ss(s)) is amended—

22 (1) in paragraph (2)(A), by striking ‘‘for which

23 an application is submitted’’ and inserting ‘‘in the

24 case of an individual for whom an application is sub25 mitted prior to or’’,
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1 (2) in paragraph (2)(A), by striking ‘‘in which

2 the individual (who is 65 years of age or older) first

3 is enrolled for benefits under part B’’ and inserting

4 ‘‘as of the first day on which the individual is 65

5 years of age or older and is enrolled for benefits

6 under part B’’, and

7 (3) in paragraph (2)(B), by striking ‘‘before it’’

8 and inserting ‘‘before the policy’’.

9 (h) MEDICARE SELECT POLICIES.—

10 (1) Section 1882(t) (42 U.S.C. 1395ss(t)) is

11 amended—

12 (A) in paragraph (1), by inserting ‘‘medi13 care supplemental’’ after ‘‘If a’’,

14 (B) in paragraph (1), by striking ‘‘NAIC

15 Model Standards’’ and inserting ‘‘1991 NAIC

16 Model Regulation or 1991 Federal Regulation’’,

17 (C) in paragraph (1)(A), by inserting ‘‘or

18 agreements’’ after ‘‘contracts’’,

19 (D) in subparagraphs (E)(i) and (F) of

20 paragraph (1), by striking ‘‘NAIC standards’’

21 and inserting ‘‘standards in the 1991 NAIC

22 Model Regulation or 1991 Federal Regulation’’,

23 and
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1 (E) in paragraph (2), by inserting ‘‘the is2 suer’’ before ‘‘is subject to a civil money pen3 alty’’.

4 (2) Section 1154(a)(4)(B) (42 U.S.C. 1320c–

5 3(a)(4)(B)) is amended—

6 (A) by inserting ‘‘that is’’ after ‘‘(or’’, and

7 (B) by striking ‘‘1882(t)’’ and inserting

8 ‘‘1882(t)(3)’’.

9 (i) HEALTH INSURANCE COUNSELING.—Section

10 4360 of OBRA–1990 is amended—

11 (1) in subsection (b)(2)(A)(ii), by striking

12 ‘‘Act’’ and inserting ‘‘Act)’’;

13 (2) in subsection (b)(2)(D), by striking ‘‘serv14 ices’’ and inserting ‘‘counseling’’;

15 (3) in subsection (b)(2)(I), by striking ‘‘assist16 ance’’ and inserting ‘‘referrals’’;

17 (4) in subsection (c)(1), by striking ‘‘and that

18 such activities will continue to be maintained at such

19 level’’;

20 (5) in subsection (d)(3), by striking ‘‘to the

21 rural areas’’ and inserting ‘‘eligible individuals resid22 ing in rural areas’’;

23 (6) in subsection (e)—

24 (A) by striking ‘‘subsection (c) or (d)’’ and

25 inserting ‘‘this section’’,
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1 (B) by striking ‘‘and annually thereafter,

2 issue an annual report’’ and inserting ‘‘and an3 nually thereafter during the period of the grant,

4 issue a report’’, and

5 (C) in paragraph (1), by striking ‘‘State6 wide’’;

7 (7) in subsection (f), by striking paragraph (2)

8 and by redesignating paragraphs (3) through (5) as

9 paragraphs (2) through (4), respectively; and

10 (8) in the second subsection (f) (relating to au11 thorization of appropriations for grants)—

12 (A) by striking ‘‘and 1993’’ and inserting

13 ‘‘1993, 1994, 1995, and 1996’’; and

14 (B) by redesignating such subsection as

15 subsection (g).

16 (j) TELEPHONE INFORMATION SYSTEM.—

17 (1) Section 1804 (42 U.S.C. 1395b–2) is

18 amended—

19 (A) by adding at the end of the heading

20 the following: ‘‘; MEDICARE AND MEDIGAP IN21 FORMATION’’,

22 (B) by inserting ‘‘(a)’’ after ‘‘1804.’’, and

23 (C) by adding at the end the following new

24 subsection:
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1 ‘‘(b) The Secretary shall provide information via a

2 toll-free telephone number on the programs under this

3 title.’’.

4 (2) Section 1882(f) (42 U.S.C. 1395ss(f)) is

5 amended by adding at the end the following new

6 paragraph:

7 ‘‘(3) The Secretary shall provide information via a

8 toll-free telephone number on medicare supplemental poli9 cies (including the relationship of State programs under

10 title XIX to such policies).’’.

11 (3) Section 1889 is repealed.

12 (k) MAILING OF POLICIES.—Section 1882(d)(4) (42

13 U.S.C. 1395ss(d)(4)) is amended—

14 (1) in subparagraph (D), by striking ‘‘, if such

15 policy’’ and all that follows up to the period at the

16 end, and

17 (2) by adding at the end the following new sub18 paragraph:

19 ‘‘(E) Subparagraph (A) shall not apply in the case

20 of an issuer who mails or causes to be mailed a policy,

21 certificate, or other matter solely to comply with the re22 quirements of subsection (q).’’.

23 (l) EFFECTIVE DATE.—The amendments made by

24 this section shall be effective as if included in the enact25 ment of OBRA–1990; except that—
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1 (1) the amendments made by subsection (d)(1)

2 shall take effect on the date of the enactment of this

3 Act, but no penalty shall be imposed under section

4 1882(d)(3)(A) of the Social Security Act (for an ac5 tion occurring after the effective date of the amend6 ments made by section 4354 of OBRA–1990 and be7 fore the date of the enactment of this Act) with re8 spect to the sale or issuance of a policy which is not

9 unlawful under section 1882(d)(3)(A)(i)(II) of the

10 Social Security Act (as amended by this section);

11 (2) the amendments made by subsection

12 (d)(2)(A) and by subparagraphs (A), (B), and (E)

13 of subsection (e)(1) shall be effective on the date

14 specified in subsection (m)(4); and

15 (3) the amendment made by subsection (g)(2)

16 shall take effect on January 1, 1995, and shall apply

17 to individuals who attain 65 years of age or older on

18 or after the effective date of section 1882(s)(2) of

19 the Social Security Act (and, in the case of individ20 uals who attained 65 years of age after such effec21 tive date and before January 1, 1995, and who were

22 not covered under such section before January 1,

23 1995, the 6-month period specified in that section

24 shall begin January 1, 1995).

25 (m) TRANSITION PROVISIONS.—
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1 (1) IN GENERAL.—If the Secretary of Health

2 and Human Services identifies a State as requiring

3 a change to its statutes or regulations to conform its

4 regulatory program to the changes made by this sec5 tion, the State regulatory program shall not be con6 sidered to be out of compliance with the require7 ments of section 1882 of the Social Security Act due

8 solely to failure to make such change until the date

9 specified in paragraph (4).

10 (2) NAIC STANDARDS.—If, within 6 months

11 after the date of the enactment of this Act, the Na12 tional Association of Insurance Commissioners (in

13 this subsection referred to as the ‘‘NAIC’’) modifies

14 its 1991 NAIC Model Regulation (adopted in July

15 1991) to conform to the amendments made by this

16 section and to delete from section 15C the exception

17 which begins with ‘‘unless’’, such revised regulation

18 incorporating the modifications shall be considered

19 to be the 1991 Regulation for the purposes of sec20 tion 1882 of the Social Security Act.

21 (3) SECRETARY STANDARDS.—If the NAIC

22 does not make the modifications described in para23 graph (2) within the period specified in such para24 graph, the Secretary of Health and Human Services

25 shall make the modifications described in such para-
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1 graph and such revised regulation incorporating the

2 modifications shall be considered to be the 1991

3 Regulation for the purposes of section 1882 of the

4 Social Security Act.

5 (4) DATE SPECIFIED.—

6 (A) IN GENERAL.—Subject to subpara7 graph (B), the date specified in this paragraph

8 for a State is the earlier of—

9 (i) the date the State changes its stat10 utes or regulations to conform its regu11 latory program to the changes made by

12 this section, or

13 (ii) 1 year after the date the NAIC or

14 the Secretary first makes the modifications

15 under paragraph (2) or (3), respectively.

16 (B) ADDITIONAL LEGISLATIVE ACTION RE17 QUIRED.—In the case of a State which the Sec18 retary identifies as—

19 (i) requiring State legislation (other

20 than legislation appropriating funds) to

21 conform its regulatory program to the

22 changes made in this section, but

23 (ii) having a legislature which is not

24 scheduled to meet in 1996 in a legislative
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1 session in which such legislation may be

2 considered,

3 the date specified in this paragraph is the first

4 day of the first calendar quarter beginning after

5 the close of the first legislative session of the

6 State legislature that begins on or after Janu7 ary 1, 1996. For purposes of the previous sen8 tence, in the case of a State that has a 2-year

9 legislative session, each year of such session

10 shall be deemed to be a separate regular session

11 of the State legislature.

12 SEC. 172. 6-MONTH EXTENSION OF PERIOD FOR ISSUANCE

13 OF MEDICARE SELECT POLICIES.

14 (a) IN GENERAL.—Section 4358(c) of the Omnibus

15 Budget Reconciliation Act of 1990 (42 U.S.C. 1320c–3

note) is amended by striking ‘‘3-year’’ and inserting ‘‘31 16 ⁄2-

17 year’’.

18 (b) EFFECTIVE DATE.—The amendment made by

19 subsection (a) shall take effect as if included in the enact20 ment of the Omnibus Budget Reconciliation Act of 1990.
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1 TITLE II—MATERNAL AND

2 CHILD HEALTH SERVICES

3 BLOCK GRANT PROGRAM

4 Subtitle A—Child Welfare, Foster

5 Care, Adoption

6 SEC. 201. INCREASE IN AUTHORIZATION OF APPROPRIA7 TIONS FOR THE MATERNAL AND CHILD

8 HEALTH SERVICES BLOCK GRANT PROGRAM.

9 Section 501(a) (42 U.S.C. 701(a)) is amended by

10 striking ‘‘$686,000,000 for fiscal year 1990’’ and insert11 ing ‘‘$705,000,000 for fiscal year 1994’’.

12 SEC. 202 REQUIRED PROTECTIONS FOR FOSTER CHIL13 DREN.

14 (a) IN GENERAL.—Section 422(b) (42 U.S.C.

15 622(b)) is amended—

16 (1) by striking ‘‘and’’ at the end of paragraph

17 (7);

18 (2) by striking the period at the end of para19 graph (8) and inserting ‘‘; and’’; and

20 (3) by adding at the end the following:

21 ‘‘(9) provide assurances that the State—

22 ‘‘(A) since June 17, 1980, has completed

23 an inventory of all children who, before the in24 ventory, had been in foster care under the re-
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1 sponsibility of the State for 6 months or more,

2 which determined—

3 ‘‘(i) the appropriateness of, and neces4 sity for, the foster care placement;

5 ‘‘(ii) whether the child could or should

6 be returned to the parents of the child or

7 should be freed for adoption or other per8 manent placement; and

9 ‘‘(iii) the services necessary to facili10 tate the return of the child or the place11 ment of the child for adoption or legal

12 guardianship;

13 ‘‘(B) is operating, to the satisfaction of the

14 Secretary—

15 ‘‘(i) a statewide information system

16 from which can be readily determined the

17 status, demographic characteristics, loca18 tion, and goals for the placement of every

19 child who is (or, within the immediately

20 preceding 12 months, has been) in foster

21 care;

22 ‘‘(ii) a case review system (as defined

23 in section 475(5)) for each child receiving

24 foster care under the supervision of the

25 State;
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1 ‘‘(iii) a service program designed to

2 help children—

3 ‘‘(I) where appropriate, return to

4 families from which they have been

5 removed; or

6 ‘‘(II) be placed for adoption, with

7 a legal guardian, or, if adoption or

8 legal guardianship is determined not

9 to be appropriate for a child, in some

10 other planned, permanent living ar11 rangement; and

12 ‘‘(iv) a preplacement preventive serv13 ices program designed to help children at

14 risk of foster care placement remain with

15 their families; and

16 ‘‘(C)(i) has reviewed (or within 12 months

17 after the date of the enactment of this para18 graph will review) State policies and adminis19 trative and judicial procedures in effect for chil20 dren abandoned at or shortly after birth (in21 cluding policies and procedures providing for

22 legal representation of such children); and

23 ‘‘(ii) is implementing (or within 24 months

24 after the date of the enactment of this para25 graph will implement) such policies and proce-
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1 dures as the State determines, on the basis of

2 the review described in clause (i), to be nec3 essary to enable permanent decisions to be

4 made expeditiously with respect to the place5 ment of such children.’’.

6 (b) RESTRICTION ON REALLOTMENT.—Section 424

7 (42 U.S.C. 624) is amended—

8 (1) in the first sentence, by striking ‘‘The

9 amount’’ and inserting the following:

10 ‘‘(a) IN GENERAL.—Subject to subsection (b), the

11 amount’’; and

12 (2) by adding at the end the following:

13 ‘‘(b) EXCEPTION RELATING TO FOSTER CHILD PRO14 TECTIONS.—The Secretary shall not reallot under sub15 section (a) of this section any amount that is withheld or

16 recovered from a State due to the failure of the State to

17 meet the requirements of section 422(b)(9).’’.

18 (c) REPEAL.—Section 427 (42 U.S.C. 627) is hereby

19 repealed.

20 (d) CONFORMING AMENDMENTS.—

21 (1) Section 423(a) (42 U.S.C. 623(a)) is

22 amended by striking ‘‘and in section 427’’.

23 (2) Section 425(a)(2) (42 U.S.C. 625(a)(2)) is

24 amended by striking ‘‘the statistical report required

25 by section’’ and inserting ‘‘section 422(b)(9) or’’.
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1 (3) Section 472(d) (42 U.S.C. 672(d)) is

2 amended by striking ‘‘427(b)’’ and inserting

3 ‘‘422(b)(9)’’.

4 (e) EFFECTIVE DATE.—The amendments and repeal

5 made by this section shall be effective with respect to fiscal

6 years beginning on or after April 1, 1995.

7 SEC. 203. CONFORMITY REVIEWS.

8 (a) IN GENERAL.—Part A of title XI (42 U.S.C.

9 1301–1320b–13) is amended by inserting after section

10 1122 the following:

11 ‘‘REVIEWS OF CHILD AND FAMILY SERVICES PROGRAMS,

12 AND OF FOSTER CARE AND ADOPTION ASSISTANCE

13 PROGRAMS, FOR CONFORMITY WITH STATE PLAN RE14 QUIREMENTS

15 ‘‘SEC. 1123. (a) IN GENERAL.—The Secretary, in

16 consultation with the State agencies administering the

17 State programs under parts B and E of title IV, shall pro18 mulgate regulations for the review of such programs to

19 determine whether such programs are in substantial con20 formity with—

21 ‘‘(1) State plan requirements under such parts

22 B and E,

23 ‘‘(2) implementing regulations promulgated by

24 the Secretary, and

25 ‘‘(3) the relevant approved State plans.
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1 ‘‘(b) ELEMENTS OF REVIEW SYSTEM.—The regula2 tions referred to in subsection (a) shall—

3 ‘‘(1) specify the timetable for conformity re4 views of State programs, including—

5 ‘‘(A) an initial review of each State pro6 gram;

7 ‘‘(B) a timely review of a State program

8 following a review in which such program was

9 found not to be in substantial conformity; and

10 ‘‘(C) less frequent reviews of State pro11 grams which have been found to be in substan12 tial conformity, but such regulations shall per13 mit the Secretary to reinstate more frequent re14 views based on information which indicates that

15 a State program may not be in conformity;

16 ‘‘(2) specify the requirements subject to review,

17 and the criteria to be used to measure conformity

18 with such requirements and to determine whether

19 there is a substantial failure to so conform;

20 ‘‘(3) specify the method to be used to determine

21 the amount of any Federal matching funds to be

22 withheld (subject to paragraph (4)) due to the State

23 program’s failure to so conform, which ensures

24 that—
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1 ‘‘(A) such funds will not be withheld with

2 respect to a program, unless it is determined

3 that the program fails substantially to so con4 form;

5 ‘‘(B) such funds will not be withheld for a

6 failure to so conform resulting from the State’s

7 reliance upon and correct use of formal written

8 statements of Federal law or policy provided to

9 the State by the Secretary; and

10 ‘‘(C) the amount of such funds withheld is

11 related to the extent of the failure to so con12 form; and

13 ‘‘(4) require the Secretary, with respect to any

14 State program found to have failed substantially to

15 so conform—

16 ‘‘(A) to afford the State an opportunity to

17 adopt and implement a corrective action plan,

18 approved by the Secretary, designed to end the

19 failure to so conform;

20 ‘‘(B) to make technical assistance available

21 to the State to the extent feasible to enable the

22 State to develop and implement such a correc23 tive action plan;
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1 ‘‘(C) to suspend the withholding of any

2 Federal matching funds under this section while

3 such a corrective action plan is in effect; and

4 ‘‘(D) to rescind any such withholding if the

5 failure to so conform is ended by successful

6 completion of such a corrective action plan.

7 ‘‘(c) PROVISIONS FOR ADMINISTRATIVE AND JUDI8 CIAL REVIEW.—The regulations referred to in subsection

9 (a) shall—

10 ‘‘(1) require the Secretary, not later than 10

11 days after a final determination that a program of

12 the State is not in conformity, to notify the State

13 of—

14 ‘‘(A) the basis for the determination; and

15 ‘‘(B) the amount of the Federal matching

16 funds (if any) to be withheld from the State;

17 ‘‘(2) afford the State an opportunity to appeal

18 the determination to the Departmental Appeals

19 Board within 60 days after receipt of the notice de20 scribed in paragraph (1) (or, if later, after failure to

21 continue or to complete a corrective action plan);

22 and

23 ‘‘(3) afford the State an opportunity to obtain

24 judicial review of an adverse decision of the Board,

25 within 60 days after the State receives notice of the
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1 decision of the Board, by appeal to the district court

2 of the United States for the judicial district in which

3 the principal or headquarters office of the agency re4 sponsible for administering the program is located.’’.

5 (b) CONFORMING AMENDMENT.—Section 471(b) (42

6 U.S.C. 671(b)) is amended by striking all that follows the

7 first sentence.

8 (c) EFFECTIVE DATES.—

9 (1) IN GENERAL.—The amendment made by

10 subsection (a) shall take effect on the date of the en11 actment of this Act.

12 (2) CONFORMING AMENDMENT.—The amend13 ment made by subsection (b) shall take effect on Oc14 tober 1, 1995.

15 (3) REGULATIONS.—The Secretary shall pro16 mulgate the regulations referred to in section

17 1123(a) of the Social Security Act (as added by this

18 section) not later than July 1, 1995, to take effect

19 on April 1, 1996.

20 SEC. 204. STATES REQUIRED TO REPORT ON MEASURES

21 TAKEN TO COMPLY WITH THE INDIAN CHILD

22 WELFARE ACT.

23 (a) STATE PLAN REQUIREMENT.—Section 422(b)

24 (42 U.S.C. 622(b)), as amended by section 301(a), is

25 amended—
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1 (1) by striking ‘‘and’’ at the end of paragraph

2 (8);

3 (2) by striking the period at the end of para4 graph (9) and inserting ‘‘; and’’; and

5 (3) by adding at the end the following:

6 ‘‘(10) contain a description, developed after

7 consultation with tribal organizations (as defined in

8 section 4 of the Indian Self-Determination and Edu9 cation Assistance Act) in the State, of the specific

10 measures taken by the State to comply with the In11 dian Child Welfare Act.’’.

12 (b) EFFECTIVE DATE.—The amendments made by

13 subsection (a) shall be effective with respect to fiscal years

14 beginning on or after October 1, 1995.

15 SEC. 205. CHILD WELFARE TRAINEESHIPS.

16 (a) IN GENERAL.—Subpart 1 of part B of title IV

17 (42 U.S.C. 620–628) is amended by inserting after section

18 428 the following:

19 ‘‘CHILD WELFARE TRAINEESHIPS

20 ‘‘SEC. 429. The Secretary may approve an applica21 tion for a grant to a public or nonprofit institution for

22 higher learning to provide traineeships with stipends

23 under section 426(a)(1)(C) only if the application—

24 ‘‘(1) provides assurances that each individual

25 who receives a stipend with such traineeship (in this

26 section referred to as a ‘recipient’) will enter into an
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1 agreement with the institution under which the re2 cipient agrees—

3 ‘‘(A) to participate in training at a public

4 or private nonprofit child welfare agency on a

5 regular basis (as determined by the Secretary)

6 for the period of the traineeship;

7 ‘‘(B) to be employed for a period of years

8 equivalent to the period of the traineeship, in a

9 public or private nonprofit child welfare agency

10 in any State, within a period of time (deter11 mined by the Secretary in accordance with reg12 ulations) after completing the postsecondary

13 education for which the traineeship was

14 awarded;

15 ‘‘(C) to furnish to the institution and the

16 Secretary evidence of compliance with subpara17 graphs (A) and (B); and

18 ‘‘(D) if the recipient fails to comply with

19 subparagraph (A) or (B) and does not qualify

20 for any exception to this subparagraph which

21 the Secretary may prescribe in regulations, to

22 repay to the Secretary all (or an appropriately

23 prorated part) of the amount of the stipend,

24 plus interest, and, if applicable, reasonable col-
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1 lection fees (in accordance with regulations pro2 mulgated by the Secretary);

3 ‘‘(2) provides assurances that the institution

4 will—

5 ‘‘(A) enter into agreements with child wel6 fare agencies for onsite training of recipients;

7 ‘‘(B) permit an individual who is employed

8 in the field of child welfare services to apply for

9 a traineeship with a stipend if the traineeship

10 furthers the progress of the individual toward

11 the completion of degree requirements; and

12 ‘‘(C) develop and implement a system that,

13 for the 3-year period that begins on the date

14 any recipient completes a child welfare services

15 program of study, tracks the employment

16 record of the recipient, for the purpose of deter17 mining the percentage of recipients who secure

18 employment in the field of child welfare services

19 and remain employed in the field.’’.

20 (b) CONFORMING AMENDMENT.—Section

21 426(a)(1)(C) (42 U.S.C. 626(a)(1)(C)) is amended by in22 serting ‘‘described in section 429’’ after ‘‘including

23 traineeships’’.
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1 (c) APPLICABILITY.—The amendments made by this

2 section shall apply to grants awarded on or after October

3 1, 1995

4 SEC. 206. DISPOSITIONAL HEARING.

5 (a) MOST APPROPRIATE SETTING.—Section

6 475(5)(A) (42 U.S.C. 675(5)(A)) is amended by inserting

7 ‘‘and most appropriate’’ after ‘‘(most family like)’’.

8 (b) TIMING OF SUBSEQUENT REVIEW.—Section

9 475(5)(C) (42 U.S.C. 675(5)(C)) is amended by striking

10 ‘‘periodically’’ and inserting ‘‘not less frequently than

11 every 12 months’’.

12 (c) EFFECTIVE DATE.—The amendments made by

13 this section shall take effect on October 1, 1995.

14 SEC. 207. ELIMINATION OF FOSTER CARE CEILINGS AND

15 OF AUTHORITY TO TRANSFER UNUSED FOS16 TER CARE FUNDS TO CHILD WELFARE SERV17 ICES PROGRAMS.

18 (a) REPEAL.—Subsections (b) and (c) of section 474

19 (42 U.S.C. 674 (b) and (c)) are hereby repealed.

20 (b) CONFORMING AMENDMENTS.—Section 474 (42

21 U.S.C. 674) is amended—

22 (1) in subsection (d)(1)—

23 (A) by striking ‘‘subsections (a), (b), and

24 (c)’’ and inserting ‘‘subsection (a)’’; and
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1 (B) by striking ‘‘the provisions of such

2 subsections’’ and inserting ‘‘subsection (a)’’;

3 and

4 (2) by redesignating subsection (d) as sub5 section (b).

6 (c) EFFECTIVE DATE.—The amendments and re7 peals made by this section shall apply to payments for cal8 endar quarters beginning on or after October 1, 1993.

9 SEC. 208. DEMONSTRATION PROJECTS.

10 Part A of title XI (42 U.S.C. 1301–1320b–13) is

11 amended by inserting after section 1128B the following:

12 ‘‘DEMONSTRATION PROJECTS

13 ‘‘SEC. 1129. (a) IN GENERAL.—The Secretary may

14 authorize not more than 10 States to conduct demonstra15 tion projects pursuant to this section which the Secretary

16 finds are likely to promote the objectives of part B or E

17 of title IV.

18 ‘‘(b) WAIVER AUTHORITY.—The Secretary may

19 waive compliance with any requirement of part B or E

20 of title IV which (if applied) would prevent a State from

21 carrying out a demonstration project under this section

22 or prevent the State from effectively achieving the purpose

23 of such a project, except that the Secretary may not

24 waive—
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1 ‘‘(1) any provision of section 427 (as in effect

2 before April 1, 1996), section 422(b)(9) (as in effect

3 after such date), or section 479; or

4 ‘‘(2) any provision of such part E, to the extent

5 that the waiver would impair the entitlement of any

6 qualified child or family to benefits under a State

7 plan approved under such part E.

8 ‘‘(c) TREATMENT AS PROGRAM EXPENDITURES.—

9 For purposes of parts B and E of title IV, the Secretary

10 shall consider the expenditures of any State to conduct

11 a demonstration project under this section to be expendi12 tures under subpart 1 or 2 of such part B, or under such

13 part E, as the State may elect.

14 ‘‘(d) DURATION OF DEMONSTRATION.—A dem15 onstration project under this section may be conducted for

16 not more than 5 years.

17 ‘‘(e) APPLICATION.—Any State seeking to conduct a

18 demonstration project under this section shall submit to

19 the Secretary an application, in such form as the Sec20 retary may require, which includes—

21 ‘‘(1) a description of the proposed project, the

22 geographic area in which the proposed project would

23 be conducted, the children or families who would be

24 served by the proposed project, and the services

25 which would be provided by the proposed project
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1 (which shall provide, where appropriate, for random

2 assignment of children and families to groups served

3 under the project and to control groups);

4 ‘‘(2) a statement of the period during which the

5 proposed project would be conducted;

6 ‘‘(3) a discussion of the benefits that are ex7 pected from the proposed project (compared to a

8 continuation of activities under the approved plan or

9 plans of the State);

10 ‘‘(4) an estimate of the costs or savings of the

11 proposed project;

12 ‘‘(5) a statement of program requirements for

13 which waivers would be needed to permit the pro14 posed project to be conducted;

15 ‘‘(6) a description of the proposed evaluation

16 design; and

17 ‘‘(7) such additional information as the Sec18 retary may require.

19 ‘‘(f) EVALUATIONS; REPORT.—Each State authorized

20 to conduct a demonstration project under this section

21 shall—

22 ‘‘(1) obtain an evaluation by an independent

23 contractor of the effectiveness of the project, using

24 an evaluation design approved by the Secretary

25 which provides for—
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1 ‘‘(A) comparison of methods of service de2 livery under the project, and such methods

3 under a State plan or plans, with respect to ef4 ficiency, economy, and any other appropriate

5 measures of program management;

6 ‘‘(B) comparison of outcomes for children

7 and families (and groups of children and fami8 lies) under the project, and such outcomes

9 under a State plan or plans, for purposes of as10 sessing the effectiveness of the project in

11 achieving program goals; and

12 ‘‘(C) any other information that the Sec13 retary may require; and

14 ‘‘(2) provide interim and final evaluation re15 ports to the Secretary, at such times and in such

16 manner as the Secretary may require.

17 ‘‘(g) COST NEUTRALITY.—The Secretary may not

18 authorize a State to conduct a demonstration project

19 under this section unless the Secretary determines that

20 the total amount of Federal funds that will be expended

21 under (or by reason of) the project over its approved term

22 (or such portion thereof or other period as the Secretary

23 may find appropriate) will not exceed the amount of such

24 funds that would be expended by the State under the State
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1 plans approved under parts B and E of title IV if the

2 project were not conducted.’’.

3 SEC. 209. PLACEMENT ACCOUNTABILITY.

4 (a) CASE PLAN REQUIREMENTS.—Section 475(5)(A)

5 (42 U.S.C. 675(5)(A)), as amended by section 305(a), is

6 amended by adding at the end the following: ‘‘which—

7 ‘‘(i) if the child has been placed in a

8 foster family home or child-care institution

9 a substantial distance from the home of

10 the parents of the child, or in a State dif11 ferent from the State in which such home

12 is located, sets forth the reasons why such

13 placement is in the best interests of the

14 child, and

15 ‘‘(ii) if the child has been placed in

16 foster care outside the State in which the

17 home of the parents of the child is located,

18 requires that, periodically, but not less fre19 quently than every 12 months, a case20 worker on the staff of the State agency of

21 the State in which the home of the parents

22 of the child is located, or of the State in

23 which the child has been placed, visit such

24 child in such home or institution and sub25 mit a report on such visit to the State
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1 agency of the State in which the home of

2 the parents of the child is located,’’.

3 (b) DISPOSITIONAL HEARING.—Section 475(5)(C)

4 (42 U.S.C. 675(5)(C)), as amended by section 305(b), is

5 amended by inserting ‘‘and, in the case of a child de6 scribed in subparagraph (A)(ii), whether the out-of-State

7 placement continues to be appropriate and in the best in8 terests of the child,’’ after ‘‘long-term basis)’’.

9 (c) DATA COLLECTION.—Section 479(c)(3)(C) (42

10 U.S.C. 679(c)(3)(C)) is amended—

11 (1) by striking ‘‘and’’ at the end of clause (i);

12 and

13 (2) by adding at the end the following:

14 ‘‘(iii) children placed in foster care

15 outside the State which has placement and

16 care responsibility, and’’.

17 (d) EFFECTIVE DATES.—The amendments made by

18 this section shall be effective with respect to fiscal years

19 beginning on or after October 1, 1995.

20 SEC. 210. PAYMENTS OF STATE CLAIMS FOR FOSTER CARE

21 AND ADOPTION ASSISTANCE.

22 (a) IN GENERAL.—Section 474(b) (42 U.S.C.

23 674(b)), as redesignated by section 306(b)(2), is amended

24 by adding at the end the following:
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1 ‘‘(4)(A) Within 60 days after receipt of a State claim

2 for expenditures pursuant to subsection (a), the Secretary

3 shall allow, disallow, or defer such claim.

4 ‘‘(B) Within 15 days after a decision to defer such

5 a State claim, the Secretary shall notify the State of the

6 reasons for the deferral and of the additional information

7 necessary to determine the allowability of the claim.

8 ‘‘(C) Within 90 days after receiving such necessary

9 information (in readily reviewable form), the Secretary

10 shall—

11 ‘‘(i) disallow the claim, if able to complete the

12 review and determine that the claim is not allowable,

13 or

14 ‘‘(ii) in any other case, allow the claim, subject

15 to disallowance (as necessary)—

16 ‘‘(I) upon completion of the review, if it is

17 determined that the claim is not allowable; or

18 ‘‘(II) on the basis of findings of an audit

19 or financial management review.’’.

20 (b) EFFECTIVE DATE.—The amendment made by

21 subsection (a) shall be effective with respect to claims

22 made on or after the date of the enactment of this Act.
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1 SEC. 211. EFFECT OF FAILURE TO CARRY OUT STATE

2 PLAN.

3 (a) IN GENERAL.—Part A of title XI (42 U.S.C.

4 1301–1320b–13), as amended by section 307, is amended

5 by inserting after section 1129 the following:

6 ‘‘EFFECT OF FAILURE TO CARRY OUT STATE PLAN

7 ‘‘SEC. 1130. In an action brought to enforce a provi8 sion of the Social Security Act, such provision is not to

9 be deemed unenforceable because of its inclusion in a sec10 tion of the Act requiring a State plan or specifying the

11 required contents of a State plan. This section is not in12 tended to limit or expand the grounds for determining the

13 availability of private actions to enforce State plan re14 quirements other than by overturning any such grounds

15 applied in Suter v. Artist M., 112 S. Ct. 1360 (1992),

16 but not applied in prior Supreme Court decisions respect17 ing such enforceability: Provided, however, That this sec18 tion is not intended to alter the holding in Suter v. Artist

19 M. that section 471(a)(15) of the Act is not enforceable

20 in a private right of action.’’.

21 (b) APPLICABILITY.—The amendment made by sub22 section (a) shall apply to actions pending on the date of

23 the enactment of this Act and to actions brought on or

24 after such date of enactment.
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1 Subtitle B—Child Support

2 Enforcement

3 SEC. 212. REPORTS TO CREDIT BUREAUS ON PERSONS DE4 LINQUENT IN CHILD SUPPORT PAYMENTS.

5 (a) IN GENERAL.—Section 466(a)(7) (42 U.S.C.

6 666(a)(7)) is amended—

7 (1) by striking ‘‘Procedures’’ and all that fol8 lows through ‘‘request of such agency’’ and inserting

9 ‘‘Procedures which require the State to periodically

10 report to consumer reporting agencies (as defined in

11 section 603(f) of the Fair Credit Reporting Act (15

12 U.S.C. 1681a(f))) the name of any parent who owes

13 overdue support and is at least 2 months delinquent

14 in the payment of such support and the amount of

15 such delinquency; and

16 (2) by striking ‘‘(C) a fee’’ and all that follows

17 through ‘‘by the State’’ and inserting ‘‘(C) such in18 formation shall not be made available to (i) a

19 consumer reporting agency which the State deter20 mines does not have sufficient capability to system21 atically and timely make accurate use of such infor22 mation, or (ii) an entity which has not furnished evi23 dence satisfactory to the State that the entity is a

24 consumer reporting agency’’.
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1 (b) EFFECTIVE DATE.—The amendments made by

2 subsection (a) shall take effect on October 1, 1995.

3 SEC. 213. TECHNICAL AMENDMENTS TO PROVISION ON

4 STATE PATERNITY ESTABLISHMENT PRO5 GRAMS.

6 Section 452(g)(2)(A) (42 U.S.C. 652(g)(2)(A)), as

7 amended by section 13721(a) of OBRA–1993, is amend8 ed—

9 (1) in clause (i), by striking ‘‘during the fiscal

10 year’’;

11 (2) in subclause (I) of clause (ii), by striking

12 ‘‘as of the end of the fiscal year’’ and inserting ‘‘in

13 the fiscal year or, at the option of the State, as of

14 the end of such year’’;

15 (3) in subclause (II) of clause (ii), by striking

16 ‘‘or (E) as of the end of the fiscal year’’ and insert17 ing ‘‘in the fiscal year or, at the option of the State,

18 as of the end of such year’’;

19 (4) in clause (iii), by striking ‘‘during the fiscal

20 year’’; and

21 (5) in the matter following clause (iii)—

22 (A) by striking ‘‘who were born out of wed23 lock during the immediately preceding fiscal

24 year’’ and inserting ‘‘born out of wedlock’’;
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1 (B) by striking ‘‘such preceding fiscal

2 year’’ both places it appears and inserting ‘‘the

3 preceding fiscal year’’; and

4 (C) by striking ‘‘or E’’ the second place it

5 appears.

6 SEC. 214. AGREEMENT TO ASSIST IN LOCATING MISSING

7 CHILDREN UNDER THE PARENT LOCATOR

8 SERVICE.

9 (a) IN GENERAL.—Section 463 (42 U.S.C. 663) is

10 amended by adding at the end the following new sub11 section:

12 ‘‘(f) The Secretary shall enter into an agreement with

13 the Attorney General of the United States, under which

14 the services of the Parent Locator Service established

15 under section 453 shall be made available to the Office

16 of Juvenile Justice and Delinquency Prevention upon its

17 request to locate any parent or child on behalf of such

18 Office for the purpose of—

19 ‘‘(1) enforcing any State or Federal law with

20 respect to the unlawful taking or restraint of a child,

21 or

22 ‘‘(2) making or enforcing a child custody deter23 mination.

24 The Parent Locator Service shall charge no fees for serv25 ices requested pursuant to this subsection.’’.
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1 (b) CONFORMING AMENDMENT.—Section 463(c) (42

2 U.S.C. 663(c)) is amended by striking ‘‘(a), (b), or (e)’’

3 and inserting ‘‘(a), (b), (e), or (f)’’.

4 (c) EFFECTIVE DATE.—The amendments made by

5 this section shall take effect on October 1, 1995.

6 Subtitle C—Supplemental Security

7 Income

8 SEC. 221. DEFINITION OF DISABILITY FOR CHILDREN

9 UNDER AGE 18 APPLIED TO ALL INDIVIDUALS

10 UNDER AGE 18.

11 (a) IN GENERAL.—Section 1614(a)(3) (42 U.S.C.

12 1382c(a)(3)) is amended—

13 (1) in subparagraphs (A) and (H), by striking

14 ‘‘a child’’ each place it appears and inserting ‘‘an in15 dividual’’; and

16 (2) in subparagraph (H), by striking ‘‘child’’

17 the second and third place it appears and inserting

18 ‘‘individual’’.

19 (b) EFFECTIVE DATE.—The amendments made by

20 subsection (a) shall apply to determinations made on or

21 after the date of the enactment of this Act.
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1 Subtitle D—Aid to Families With

2 Dependent Children

3 SEC. 231. SIMPLIFICATION OF INCOME AND ELIGIBILITY

4 VERIFICATION SYSTEM.

5 Paragraph (1)(A) of section 1137(d) (42 U.S.C.

6 1320b–7(d)) is amended to read as follows:

7 ‘‘(1)(A) The State shall require, as a condition

8 of an individual’s eligibility for benefits under a pro9 gram listed in subsection (b), a declaration in writ10 ing, under penalty of perjury—

11 ‘‘(i) by the individual,

12 ‘‘(ii) in the case in which eligibility for pro13 gram benefits is determined on a family or

14 household basis, by any adult member of such

15 individual’s family or household (as applicable),

16 or

17 ‘‘(iii) in the case of an individual born into

18 a family or household receiving benefits under

19 such program, by any adult member of such

20 family or household no later than the next rede21 termination of eligibility of such family or

22 household following the birth of such individual,

23 stating whether the individual is a citizen or national

24 of the United States, and, if that individual is not
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1 a citizen or national of the United States, that the

2 individual is in a satisfactory immigration status.’’.

3 SEC. 232. MEASUREMENT AND REPORTING OF WELFARE

4 RECEIPT.

5 (a) CONGRESSIONAL POLICY.—The Congress hereby

6 declares that—

7 (1) it is the policy and responsibility of the

8 Federal Government to reduce the rate at which and

9 the degree to which families depend on income from

10 welfare programs and the duration of welfare re11 ceipt, consistent with other essential national goals;

12 (2) it is the policy of the United States to

13 strengthen families, to ensure that children grow up

14 in families that are economically self-sufficient and

15 that the life prospects of children are improved, and

16 to underscore the responsibility of parents to sup17 port their children;

18 (3) the Federal Government should help welfare

19 recipients as well as individuals at risk of welfare re20 ceipt to improve their education and job skills, to ob21 tain child care and other necessary support services,

22 and to take such other steps as may be necessary to

23 assist them to become financially independent; and

24 (4) it is the purpose of this section to provide

25 the public with generally accepted measures of wel-
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1 fare receipt so that it can track such receipt over

2 time and determine whether progress is being made

3 in reducing the rate at which and, to the extent fea4 sible, the degree to which, families depend on income

5 from welfare programs and the duration of welfare

6 receipt.

7 (b) DEVELOPMENT OF WELFARE INDICATORS AND

8 PREDICTORS.—The Secretary of Health and Human Serv9 ices (in this section referred to as the ‘‘Secretary’’) in con10 sultation with the Secretary of Agriculture shall—

11 (1) develop—

12 (A) indicators of the rate at which and, to

13 the extent feasible, the degree to which, families

14 depend on income from welfare programs and

15 the duration of welfare receipt; and

16 (B) predictors of welfare receipt;

17 (2) assess the data needed to report annually

18 on the indicators and predictors, including the abil19 ity of existing data collection efforts to provide such

20 data and any additional data collection needs; and

21 (3) not later than 2 years after the date of the

22 enactment of this section, provide an interim report

23 containing conclusions resulting from the develop24 ment and assessment described in paragraphs (1)

25 and (2), to—
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1 (A) the Committee on Ways and Means of

2 the House of Representatives;

3 (B) the Committee on Education and

4 Labor of the House of Representatives;

5 (C) the Committee on Agriculture of the

6 House of Representatives;

7 (D) the Committee on Energy and Com8 merce of the House of Representatives;

9 (E) the Committee on Finance of the Sen10 ate;

11 (F) the Committee on Labor and Human

12 Resources of the Senate; and

13 (G) the Committee on Agriculture, Nutri14 tion, and Forestry of the Senate.

15 (c) ADVISORY BOARD ON WELFARE INDICATORS.—

16 (1) ESTABLISHMENT.—There is established an

17 Advisory Board on Welfare Indicators (in this sub18 section referred to as the ‘‘Board’’).

19 (2) COMPOSITION.—The Board shall be com20 posed of 12 members with equal numbers to be ap21 pointed by the House of Representatives, the Senate,

22 and the President. The Board shall be composed of

23 experts in the fields of welfare research and welfare

24 statistical methodology, representatives of State and
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1 local welfare agencies, and organizations concerned

2 with welfare issues.

3 (3) VACANCIES.—Any vacancy occurring in the

4 membership of the Board shall be filled in the same

5 manner as the original appointment for the position

6 being vacated. The vacancy shall not affect the

7 power of the remaining members to execute the du8 ties of the Board.

9 (4) DUTIES.—Duties of the Board shall in10 clude—

11 (A) providing advice and recommendations

12 to the Secretary on the development of indica13 tors of the rate at which and, to the extent fea14 sible, the degree to which, families depend on

15 income from welfare programs and the duration

16 of welfare receipt; and

17 (B) providing advice on the development

18 and presentation of annual reports required

19 under subsection (d).

20 (5) TRAVEL EXPENSES.—Members of the

21 Board shall not be compensated, but shall receive

22 travel expenses, including per diem in lieu of subsist23 ence, at rates authorized for employees of agencies

24 under subchapter I of chapter 57 of title 5, United

25 States Code, for each day the member is engaged in
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1 the performance of duties away from the home or

2 regular place of business of the member.

3 (6) DETAIL OF FEDERAL EMPLOYEES.—The

4 Secretary shall detail, without reimbursement, any

5 of the personnel of the Department of Health and

6 Human Services to the Board to assist the Board in

7 carrying out its duties. Any detail shall not interrupt

8 or otherwise affect the civil service status or privi9 leges of the Federal employee.

10 (7) VOLUNTARY SERVICE.—Notwithstanding

11 section 1342 of title 31, United States Code, the

12 Board may accept the voluntary services provided by

13 a member of the Board.

14 (8) TERMINATION OF BOARD.—The Board shall

15 be terminated at such time as the Secretary deter16 mines the duties described in paragraph (4) have

17 been completed, but in any case prior to the submis18 sion of the first report required under subsection

19 (d).

20 (d) ANNUAL WELFARE INDICATORS REPORT.—

21 (1) PREPARATION.—The Secretary shall pre22 pare annual reports on welfare receipt in the United

23 States.

24 (2) COVERAGE.—The report shall include anal25 ysis of families and individuals receiving assistance
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1 under means-tested benefit programs, including the

2 program of aid to families with dependent children

3 under part A of title IV of the Social Security Act

4 (42 U.S.C. 601 et seq.), the food stamp program

5 under the Food Stamp Act of 1977 (7 U.S.C. 2011

6 et seq.), and the Supplemental Security Income pro7 gram under title XVI of the Social Security Act (42

8 U.S.C. 1381 et seq.), or as general assistance under

9 programs administered by State and local govern10 ments.

11 (3) CONTENTS.—Each report shall set forth for

12 each of the means-tested benefit programs described

13 in paragraph (2)—

14 (A) indicators of—

15 (i) the rate at which and, to the ex16 tent feasible, the degree to which, families

17 depend on income from welfare programs,

18 and

19 (ii) the duration of welfare receipt;

20 (B) trends in indicators;

21 (C) predictors of welfare receipt;

22 (D) the causes of welfare receipt;

23 (E) patterns of multiple program receipt;

24 (F) such other information as the Sec25 retary deems relevant; and
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1 (G) such recommendations for legislation,

2 which shall not include proposals to reduce eli3 gibility levels or impose barriers to program ac4 cess, as the Secretary may determine to be nec5 essary or desirable to reduce—

6 (i) the rate at which and the degree to

7 which families depend on income from wel8 fare programs, and

9 (ii) the duration of welfare receipt.

10 (4) SUBMISSION.—The Secretary shall submit

11 such a report not later than 3 years after the date

12 of the enactment of this section and annually there13 after, to the committees specified in subsection

14 (b)(3)(C). Each such report shall be transmitted

15 during the first 60 days of each regular session of

16 Congress.

17 (e) SHORT TITLE.—This section may be cited as the

18 ‘‘Welfare Indicators Act of 1994’’.

19 SEC. 233. NEW HOPE DEMONSTRATION PROJECT.

20 (a) IN GENERAL.—The Secretary of Health and

21 Human Services (in this section referred to as the ‘‘Sec22 retary’’) shall provide for a demonstration project for a

23 qualified program to be conducted in Milwaukee, Wiscon24 sin, in accordance with this section.
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1 (b) PAYMENTS.—For each calendar quarter in which

2 there is a qualified program approved under this sub3 section, the Secretary shall pay to the operator of the

4 qualified program, for no more than 20 calendar quarters,

5 an amount equal to the aggregate amount that would oth6 erwise have been payable to the State with respect to par7 ticipants in the program for such calendar quarter, in the

8 absence of the program, for cash assistance and child care

9 under part A of title IV of the Social Security Act, for

10 medical assistance under title XIX of such Act, and for

11 administrative expenses related to such assistance. The

12 amount payable to the operator of the program under this

13 section shall not include the costs of evaluating the effects

14 of the program.

15 (c) DEMONSTRATION PROJECT DESCRIBED.—For

16 purposes of this section, the term ‘‘qualified program’’

17 means a program operated—

18 (1) by The New Hope Project, Inc., a private,

19 not-for-profit corporation incorporated under the

20 laws of the State of Wisconsin (in this section re21 ferred to as the ‘‘operator’’), which offers low-income

22 residents of Milwaukee, Wisconsin, employment,

23 wage supplements, child care, health care, and coun24 seling and training for job retention or advancement;

25 and
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1 (2) in accordance with an application submitted

2 by the operator of the program and approved by the

3 Secretary based on the Secretary’s determination

4 that the application satisfies the requirements of

5 subsection (d).

6 (d) CONTENTS OF APPLICATION.—The operator of

7 the qualified program shall provide, in its application to

8 conduct a demonstration project for the program, that the

9 following terms and conditions will be met:

10 (1) The operator will develop and implement an

11 evaluation plan designed to provide valid and reliable

12 information on the impact and implementation of

13 the program. The evaluation plan will include ade14 quately sized groups of project participants and con15 trol groups assigned at random.

16 (2) The operator will develop and implement a

17 plan addressing the services and assistance to be

18 provided by the program, the timing and determina19 tion of payments from the Secretary to the operator

20 of the program, and the roles and responsibilities of

21 the Secretary and the operator with respect to meet22 ing the requirements of this paragraph.

23 (3) The operator will specify a reliable meth24 odology for determining expenditures to be paid to

25 the operator by the Secretary, with assistance from
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1 the Secretary in calculating the amount that would

2 otherwise have been payable to the State in the ab3 sence of the program, pursuant to subsection (b).

4 (4) The operator will issue an interim and final

5 report on the results of the evaluation described in

6 paragraph (1) to the Secretary at such times as re7 quired by the Secretary.

8 (e) EFFECTIVE DATE.—This section shall take effect

9 on the first day of the first calendar quarter that begins

10 after the date of the enactment of this Act.

11 SEC. 234. DELAY IN REQUIREMENT THAT OUTLYING

12 AREAS OPERATE AN AFDC–UP PROGRAM.

13 (a) IN GENERAL.—Section 401(g)(2) of the Family

14 Support Act of 1988 (42 U.S.C. 602 note; 102 Stat.

15 2396) is amended by striking ‘‘October 1, 1992’’ and in16 serting ‘‘the date of the repeal of the limitations contained

17 in section 1108(a) of the Social Security Act on payments

18 to such jurisdictions for purposes of making maintenance

19 payments under parts A and E of title IV of such Act’’.

20 (b) EFFECTIVE DATE.—The amendment made by

21 subsection (a) shall take effect as if included in the provi22 sion of the Family Support Act of 1988 to which the

23 amendment relates at the time such provision became law.
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1 SEC. 235. STATE OPTION TO USE RETROSPECTIVE BUDG2 ETING WITHOUT MONTHLY REPORTING.

3 (a) IN GENERAL.—Section 402(a)(13) (42 U.S.C.

4 602(a)(13)) is amended—

5 (1) by striking all that precedes subparagraph

6 (A) and inserting the following:

7 ‘‘(13) provide, at the option of the State and

8 with respect to such category or categories as the

9 State may select and identify in the State plan,

10 that—’’; and

11 (2) in each of subparagraphs (A) and (B), by

12 striking ‘‘, in the case of families who are required

13 to report monthly to the State agency pursuant to

14 paragraph (14)’’.

15 (b) EFFECTIVE DATE.—The amendment made by

16 subsection (a) shall take effect on October 1, 1994, and

17 shall apply to payments under part A of title IV of the

18 Social Security Act for fiscal year 1994 and such pay19 ments for succeeding fiscal years.

20 Subtitle E—JOBS Program

21 SEC. 241. EXPANSION OF COVERAGE FOR INDIAN TRIBES.

22 (a) IN GENERAL.—Section 482(i)(2)(A) (42 U.S.C.

23 682(i)(2)(A)) is amended by striking ‘‘members of such

24 Indian tribe receiving aid to families with dependent chil25 dren’’ and inserting ‘‘Indians receiving aid to families with
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1 dependent children who reside on the reservation or within

2 the designated service area’’.

3 (b) EFFECTIVE DATE.—The amendment made by

4 subsection (a) shall take effect on October 1, 1995.

5 SEC. 242. REPORT TO THE CONGRESS WITH RESPECT TO

6 PERFORMANCE STANDARDS IN THE JOBS

7 PROGRAM.

8 Section 487(a) (42 U.S.C. 687(a)) is amended—

9 (1) by striking ‘‘3’’ and inserting ‘‘4’’;

10 (2) in paragraph (1), by inserting ‘‘criteria for’’

11 after ‘‘develop’’;

12 (3) in paragraph (2), by striking ‘‘for’’ and in13 serting ‘‘with respect to’’; and

14 (4) in the second sentence, by striking ‘‘under

15 this subsection’’ and inserting ‘‘with respect to the

16 program under this part’’.

17 Subtitle F—Other Provisions

18 SEC. 261. EXTENSION OF DEMONSTRATION TO EXPAND

19 JOB OPPORTUNITIES.

20 (a) IN GENERAL.—Section 505 of the Family Sup21 port Act of 1988 (42 U.S.C. 1315 note; 102 Stat. 2404)

22 is amended—

23 (1) in subsection (e), by striking ‘‘3-year pe24 riod’’ and inserting ‘‘6-year period’’,
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1 (2) in subsection (f)(2), by striking ‘‘January 1,

2 1993’’ and inserting ‘‘January 1, 1995’’, and

3 (3) in subsection (g), by striking ‘‘1991, and

4 1992’’ and inserting ‘‘1991, 1992, 1993, 1994,

5 1995, and 1996’’.

6 (b) EFFECTIVE DATE.—The amendments made by

7 subsection (a) shall take effect on October 1, 1993.

8 SEC. 262. EARLY CHILDHOOD DEVELOPMENT PROJECTS.

9 Section 501(a) of the Family Support Act of 1988

10 (42 U.S.C. 1315 note; 102 Stat. 2400) is amended by add11 ing at the end the following:

12 ‘‘(4) For grants to States to conduct demonstration

13 projects under this subsection, there are authorized to be

14 appropriated not to exceed $3,000,000 for each of the fis15 cal years 1995 through 1999.’’.

16 SEC. 263. REALLOCATION OF FUNDS UNDER TITLE XX FOR

17 EMPOWERMENT AND ENTERPRISE GRANTS.

18 Section 2007 (42 U.S.C. 1397f), as added by section

19 13761 of OBRA–1993, is amended—

20 (1) by redesignating subsection (e) as sub21 section (f); and

22 (2) by inserting after subsection (d) the follow23 ing new subsection:

24 ‘‘(e) REALLOCATION OF REMAINING FUNDS.—
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1 ‘‘(1) REMITTED AMOUNTS.—The amount speci2 fied in section 2003(c) for any fiscal year is hereby

3 increased by the total of the amounts remitted dur4 ing the fiscal year pursuant to subsection (d) of this

5 section.

6 ‘‘(2) AMOUNTS NOT PAID TO THE STATES.—

7 The amount specified in section 2003(c) for fiscal

8 year 1998 is hereby increased by the amount made

9 available for grants under this section that has not

10 been paid to any State by the end of fiscal year

11 1997.’’.

12 SEC. 264. CORRECTIONS RELATED TO THE INCOME SECU13 RITY AND HUMAN RESOURCES PROVISIONS

14 OF THE OBRA–1990.

15 (a) AMENDMENT RELATED TO SECTION

16 5035(a)(2).—Section 5035(a)(2) of OBRA–1990 is

17 amended by striking ‘‘a semicolon’’ and inserting

18 ‘‘ ‘; and’ ’’.

19 (b) AMENDMENT RELATED TO SECTION 5040.—Sec20 tion 1631(n) (42 U.S.C. 1383(n)) is amended by striking

21 ‘‘subsection’’ and inserting ‘‘section’’.

22 (c) AMENDMENT RELATED TO SECTION 5051(a).—

23 Section 402(a)(14) (42 U.S.C. 602(a)(14)) is amended to

24 read as follows:
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1 ‘‘(14) at the option of the State and with re2 spect to such category or categories as the State

3 may select and identify in the plan, provide that—

4 ‘‘(A) the State agency will require each

5 family to which the State provides (or, but for

6 paragraph (22) or (32), would provide) aid to

7 families with dependent children, as a condition

8 to the continued receipt of such aid (or to con9 tinuing to be deemed to be a recipient of such

10 aid), to report to the State agency monthly (or

11 less frequently in the case of such categories of

12 recipients as the State may select) on—

13 ‘‘(i) the income of the family, the

14 composition of the family, and other rel15 evant circumstances during the prior

16 month; and

17 ‘‘(ii) the income and resources the

18 family expects to receive, or any changes in

19 circumstances affecting continued eligi20 bility for, or amount of benefits, the family

21 expects to occur, in that month or in fu22 ture months; and

23 ‘‘(B) in addition to any action that may be

24 appropriate based on other reports or informa-
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1 tion received by the State agency, the State

2 agency will—

3 ‘‘(i) take prompt action to adjust the

4 amount of assistance payable, as may be

5 appropriate, on the basis of the informa6 tion contained in the report (or upon the

7 failure of the family to submit a timely re8 port); and

9 ‘‘(ii) give the family an appropriate

10 explanatory notice concurrent with any ac11 tion taken under clause (i);’’.

12 (d) REPEAL OF PROVISION INADVERTENTLY IN13 CLUDED.—Section 5057 of OBRA–1990, and the amend14 ment made by such section, are hereby repealed, and sec15 tion 1139(d) of the Social Security Act shall be applied

16 and administered as if such section 5057 had never been

17 enacted.

18 (e) AMENDMENT RELATED TO SECTION

19 5105(a)(1)(B).—The second paragraph of section 1631(a)

20 (42 U.S.C. 1383(a)) is amended by striking ‘‘(A)(i) Pay21 ments’’ and inserting ‘‘(2)(A)(i) Payments’’.

22 (f) AMENDMENTS RELATED TO SECTION 5105(b).—

23 Section 1631(a)(2)(C) (42 U.S.C. 1383(a)(2)(C)) is

24 amended—
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1 (1) in clause (i), by striking ‘‘to representative’’

2 and inserting ‘‘to a representative’’;

3 (2) by striking clause (ii);

4 (3) by redesignating clauses (iii), (iv), and (v)

5 as clauses (ii), (iii), and (iv), respectively; and

6 (4) in clause (iv) (as so redesignated), by strik7 ing ‘‘(iii), and (iv)’’ and inserting ‘‘and (iii)’’.

8 (g) AMENDMENTS RELATED TO SECTION

9 5107(a)(2)(B).—Section 1631(c)(1)(B) (42 U.S.C.

10 1383(c)(1)(B)) is amended by striking ‘‘paragraph (1)’’

11 each place such term appears and inserting ‘‘subpara12 graph (A)’’.

13 (h) EFFECTIVE DATE.—Each amendment made by

14 this section shall take effect as if included in the provision

15 of OBRA–1990 to which the amendment relates at the

16 time such provision became law.

17 SEC. 265. TECHNICAL CORRECTIONS RELATED TO THE

18 HUMAN RESOURCE AND INCOME SECURITY

19 PROVISIONS OF THE OBRA–1989.

20 (a) AMENDMENT RELATING TO SECTION 8004(a).—

21 Section 408(m)(2)(A) (42 U.S.C. 608(m)(2)(A)) is

22 amended by striking ‘‘a fiscal’’ and inserting ‘‘the fiscal’’.

23 (b) AMENDMENT RELATING TO SECTION 8006(a).—

24 Section 473(a)(6)(B) (42 U.S.C. 673(a)(6)(B)) is amend-
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1 ed by striking ‘‘474(a)(3)(B)’’ and inserting

2 ‘‘474(a)(3)(C)’’.

3 (c) AMENDMENT RELATING TO SECTION

4 8007(b)(3).—Subparagraph (D) of section 475(5) (42

5 U.S.C. 675(5)(D)) is amended by moving such subpara6 graph 2 ems to the right so that the left margin of such

7 subparagraph is aligned with the left margin of subpara8 graph (C) of such section.

9 (d) EFFECTIVE DATE.—Each amendment made by

10 this section shall take effect as if the amendment had been

11 included in the provision of OBRA–1989 to which the

12 amendment relates, at the time the provision became law.

13 SEC. 266. TECHNICAL CORRECTION RELATED TO THE

14 HUMAN RESOURCE AND INCOME SECURITY

15 PROVISIONS OF THE OBRA–1993.

16 (a) AMENDMENT RELATING TO SECTION

17 13713(a).—Section 473(a)(6)(B) (42 U.S.C.

18 673(a)(6)(B)) is amended by striking ‘‘474(a)(3)(C)’’ and

19 inserting ‘‘474(a)(3)(E)’’.

20 (b) EFFECTIVE DATE.—The amendment made by

21 this section shall take effect as if the amendment had been

22 included in the provision of OBRA–1993 to which the

23 amendment relates, at the time the provision became law.
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1 SEC. 267. ELIMINATION OF OBSOLETE PROVISIONS RELAT2 ING TO TREATMENT OF THE EARNED IN3 COME TAX CREDIT.

4 (a) TREATMENT OF EITC AS EARNED INCOME.—

5 Section 1612(a)(1) (42 U.S.C. 1382a(a)(1)) is amended

6 by striking subparagraph (C) and by redesignating sub7 paragraphs (D) and (E) as subparagraphs (C) and (D),

8 respectively.

9 (b) ADJUSTMENT OF BENEFITS DUE TO TREAT10 MENT OF EITC AS EARNED INCOME.—Section 1631(b)

11 (42 U.S.C. 1383(b)) is amended by striking paragraph (3)

12 and by redesignating paragraphs (4) and (5) as para13 graphs (3) and (4), respectively.

14 SEC. 268. REDESIGNATION OF CERTAIN PROVISIONS.

15 Section 1631(e)(6) (42 U.S.C. 1383(e)(6)) is amend16 ed by redesignating subparagraphs (1) and (2) as sub17 paragraphs (A) and (B), respectively.

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